(Disclaimer: I've been involved in clinical trials funded by the company Allergan. Allegan makes Botox.)
In the early 2000's our lab worked with the company that makes Botox (Allergan) to update their message. Up until that point their message was pretty clear: You have spasticity, and Botox temporarily reduces it- the end.
But it is a Band-Aid. It wears off in 2-3 months. Not only does it wear off but some people- after a few injections- become immune to it. (or worse?) Once the immunity builds up it no longer works.
And, again, it's a Band-Aid.
Most survivors who have spasticity want more than a Band-Aid. They want a true reduction – a reduction not controlled by any medication.
So we worked hard with Allergan to have them change and focus their message. And, to their credit, since then in all their literature and all their communications, they have added to their message.
The old message:
Take Botox, it will reduce your spasticity.
The new message:
Once you are "under the influence" take that "vacation from spasticity" and use it as an opportunity to move towards recovery.
You've been Botoxed!! (now what?)
Once Botoxed make sure to follow up physical or occupational therapy. Have therapists work on the following:
1. Botox and repetitive practice.
Sometimes, you get lucky and the Botox "unmasks" some movement that before the Botox was not available. Let's say your hand is constantly fisted.
The doc Botoxes the muscles that close the hand. Botox usually takes 7-10 days to start to work. In this case, once it does work the muscles that open the hand are free from the overwhelming strength that causes the fisting. A bit of active finger extension (opening the hand) becomes available. From that point therapy should focus on as much repetitive practice of finger extension (hand opening) as possible.
2. Botox and electrical stimulation (EStim).
As before, imagine your finger flexors are spastic. They hold your hand in a tight fist constantly. The doctor Botoxes your finger flexors, and those flexors release – allowing the hand open. The problem is the finger extensors (the muscles that open the hand) are weak because they haven't been used. EStim does two things – it activates and strengthens the muscles that open hand, while relaxing the muscles that close to hand. This is why EStim is helpful your irrespective of Botox: EStim activates the opening of the hand while relaxing the muscles that close to hand. But when EStim is done with Botox, it magnifies both.
3. Botox and Mirror therapy
Another thing we can be tried is mirror therapy. You can find a review of mirror therapy here.