Byline: Vasundhara Sanger

MUMBAI: Botox has been largely publicised to smoothen out frown lines between eyebrows and foreheads of aging divas and fashionistas. However, it's not just the cosmetics surgeons who are seeking it out as a remedy. Dr Ashok N Johri, Hon. professor of Orthopaedic

Surgery at Grant Medical College and Sir J J Hospital in Mumbai tells Timesofindia.com that Botulinum injections (Botox) are being used to treat cerebral palsy in children. And though there is no standard cure that works for all patients of cerebral palsy, medical interventions like the use of botox has shown significant improvement in their conditions. Excerpts:

How can botox injections help in the treatment of cerebral palsy in children?

Botox controls spasticity (when the brain cannot control because tightness sets in). Administering botox relax the muscles. Cerebral Palsy (CP) is a non progressive disorder and is caused by damage to the motor control centres of the young developing brain and can occur during pregnancy, childbirth or after birth.

It has been seen that when botox is administered for cosmetic reasons it may cause harm. Is there even a slight chance of the botox treatment having an adverse effect on the patients of cerebral palsy?

One needs to identify the tight muscles first since the injection is given to control its tightness. Not a great deal of harm is done. Inadvertently, however, if it happens, then there is no big problem because the effect is reversible.

Botox helps in various ways. For instance, if the upper limb muscles of bend elbow (tightens), botox helps.

Can we call it a permanent cure or botox has to be administered to a patient at periodic intervals?

This is not a permanent treatment. Still, a percentage of patients (though small) have shown a good response to the treatment.

We tend to use botox to treat a patient first to avoid surgeries, early in life. Initially, we try out physiotherapy and if the patient does not improve then we start the botox treatment. Only when there is no significant improvement in the patient's condition, we recommend surgeries.

Can you give us a sense of the number of (botox) shots that are to be administered to patients?

The shots that we give are on the basis of body unit. If a child weighs 10 kg, the maximum that we can inject in him is 300 units (3 vials). It goes as 20 units per kg.

Is there an age restriction on the use of botox for CP?

We do not inject (botox) to a child who is less than three years of age. Children need this treatment most when they are younger and learning (physical activity). We have, however, injected botox to a six month old child for a spine problem (arching of back).

Largely, we have used this treatment from 2-3 years up to the age of 8-9 years. Beyond that if we have to inject then it is for the neglected cases of cerebral palsy. Among adults botox is being used for the stroke patients.

How have the children responded to the botox treatment?

Children respond well, mostly. There is a distinctive improvement in them.

What made you start this treatment?

I have been involved in the treatment of cerebral palsy since the 1980s. I noticed there were times when it was difficult to do surgeries. In fact, surgeries were causing more harm. Post surgeries, it was a rigorous treatment; patient compliance is required in surgeries as they need to follow up. I heard about the botox treatment at a seminar and then decided to incorporate it in the treatment of cerebral palsy.

Is botox used for any other treatment, apart from cerebral palsy?

In children, we have used it for club feet management (calf muscle tightens). Also, in cases when post delivery one pattern of paralysis affects the upper limb. This can be treated by injecting botox in the shoulder muscles. Botox aids in physiotherapy and prevents deformities.