Botox adds new wrinkle to stroke rehabilitation

PHOTO COURTESY MEMORIAL HOSPITAL
MOVING AHEAD: Heather DeLuca had use of her left hand restored thanks to Botox-injection treatment from Memorial Hospital neurologist Mason Gasper.
By Marion Davis
Contributing Writer
Posted 8/17/09

Paul Reall did not have a good 60th birthday. He had a stroke – a serious, long-term disabling one. Almost six years later, he still speaks slowly and with some difficulty. And his left foot gives him trouble when he walks; for awhile, his big toe kept sticking up.

It’s a common problem; about 58 percent of stroke survivors have neurological damage that results in tight, stiff muscles and sometimes painful muscle spasms, according to the National Stroke Association. It’s called spasticity, and it feels like really severe athletic cramps.

Doctors usually treat spasticity with drugs that block the nervous system and relax muscles, but they can cause fatigue; in some cases, nerve connections are surgically severed.

At Memorial Hospital of Rhode Island, however, Dr. Mason Gasper, a neurologist who runs a comprehensive spasticity clinic, is successfully using a different therapy: Botox.

Inject a dose of Botox in the affected muscle, and neuromuscular transmission is blocked in that area, easing any stiffness and ending the spasms. It’s localized, so the rest of the body isn’t affected, and when it wears off after about three months, you can get a fresh injection.

It’s worked like a charm for Reall, who was referred for Botox by a rehabilitation center in Johnston. “My toes are staying down now,” he said, “and my foot used to turn on me when I walked and now it [still] does on occasion, but not as much.”

Memorial is not the first to offer Botox to neurology patients; in fact, Gasper learned to use the toxin as a neurology resident at Rhode Island Hospital about seven years ago. But while scientists have known what botulinum can do for decades, most medical applications are still relatively new, and only some are approved by the U.S. Food and Drug Administration.

Botox is best known as an anti-wrinkle treatment, with about 5 million cosmetic injections given last year, according to the American Society of Plastic Surgeons. It’s produced in labs by growing the bacterium Clostridium botulinum, the same organism that causes botulism, and purifying a specific botulinum toxin, type A.

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