In the 21st century, spasticity has emerged as one of the most common neurological challenges among children. Especially, for children with cerebral palsy, traumatic brain injury, or spinal cord disorders, the increased muscle tone sends abnormal signals from the central nervous system, which leads to motor function difficulty, uneasy movement and acute stiffness.
It is important to manage spasticity effectively to improve mobility and comfort. Apart from that, a proper treatment can also reduce long-term complications, scoliosis and hip dislocation. The treatment structure ranges from local pharmacological interventions to systemic therapies, and for more critical cases, surgery is the ultimate.
Local Injections: Botulinum Toxin and Phenol
Botulinum Toxin (BoNT-A, commonly known as Botox)
- Mechanism: Blocks acetylcholine release at the neuromuscular junction, resulting in temporary relaxation of overactive muscles.
- Indications: Focal or multifocal spasticity, particularly in the upper or lower limbs.
- Duration: Effects typically last 3–6 months, after which reinjection may be required.
- Clinical Benefits: Improved range of motion, facilitation of physiotherapy, enhanced brace tolerance, and better motor control.
Phenol Injections
- Mechanism: Causes neurolysis of motor nerves, leading to longer-lasting reduction in muscle overactivity compared to Botulinum Toxin.
- Indications: More severe focal spasticity or when prolonged relief is desired.
- Duration: Can last 6–12 months.
- Clinical Benefits: Reduction in severe spasticity, improved positioning, and facilitation of daily caregiving.
Both methods are considered minimally invasive, reversible, and repeatable options for focal spasticity.
Intrathecal Baclofen Therapy (Baclofen Pump)
Baclofen is a gamma-aminobutyric acid (GABA-B) agonist that inhibits excitatory neurotransmission in the spinal cord. Oral administration is often limited by systemic side effects (e.g., sedation, weakness).
- Mechanism: A surgically implanted pump delivers baclofen directly into the intrathecal space, allowing higher concentrations at the site of action with fewer systemic effects.
- Indications: Generalized or severe spasticity unresponsive to oral medications and local injections.
- Clinical Benefits: Significant reduction in whole-body spasticity, improved ease of care, better sitting and positioning, and in some cases, improved mobility.
- Considerations: Requires surgery, ongoing pump refills, and monitoring for complications such as infection or pump malfunction.
When to Use Injections vs. Surgery
- Local injections (Botox, Phenol) are the first option when spasticity is focal, especially if it interferes with therapy, brace use, or daily activities. They are also useful for delaying orthopedic interventions by maintaining muscle flexibility.
- Baclofen Pump is appropriate for diffuse or severe spasticity not controlled by less invasive measures.
- Surgery (orthopedic or neurosurgical procedures such as selective dorsal rhizotomy) is generally considered when conservative treatments fail to provide a satisfactory outcome or when fixed contractures and deformities develop.
Integration with Rehabilitation
Pharmacological interventions are not self-sufficient treatments. The main goal of this is to facilitate physiotherapy, occupational therapy, and orthotic use, ensuring children can maximize functional progress. For this, early and combined management is essential for long-term success.
Conclusion
Spasticity management calls for personalized approach in order to balance local interventions, systematic therapy and surgical options when necessary. Botulinum toxin, phenol injections, and intrathecal baclofen pumps offer effective solutions by reducing spasticity, improving the quality of life for every child with acute neurological conditions and boosting their participation in rehabilitation.
