The latest lifeline for patients paralysed by strokes ... Botox!
IT’S normally known as an anti-wrinkle jab – but for those crippled by stroke, Botox can be a lifeline, helping to restore lost movement. Now, more NHS patients will benefit after medical watchdog the National Institute for Health and Care Excellence licensed the muscle-freezing drug for treatment of limb problems.
It follows a trial of 120 patients with post-stroke ankle difficulties which found that Botox injections enabled them to regain control and movement.
‘This is one of the most important advances for years,’ says Professor Anthony Ward, of the North Staffordshire Rehabilitation Centre. ‘By allowing the ankle to function more normally, this can bring important mobility and physical benefits to patients, even those who have been suffering from this condition for many years.’
Stroke affects at least 150,000 Britons a year and there are more than a million stroke survivors in the UK. Up to 30 per cent live with muscle stiffness, known as post-stroke spasticity.
One person who already knows the benefits of Botox is Lesley Berry, 27, who developed dystonia – a condition that causes muscles to spasm – following a stroke.
Lesley was affected throughout her left side, and her left hand was permanently clamped into a claw. It was so bad that she was unable even to hold a cup of tea. Physiotherapy and the bloodthinning medication warfarin both failed to aid her recovery and she grew so self-conscious that she barely went out.
It was only when Lesley started receiving regular Botox jabs that her body bounced back.
‘Both the stroke and its aftermath were incredibly scary,’ she says. ‘I couldn’t eat or talk or even go to the toilet by myself. I had to start everything from scratch, like a baby. When the medication and physio didn’t work, I began to despair. But Botox has helped me lead a normal life again.’
Stroke patients benefit because the botulinum toxin freezes stiff muscles to stop them spasming, and restores control of the limb.
Previous research suggested injections could help stroke victims regain movement in arms and hands. The new study shows it can help lower limbs too, allowing feet to function normally and straightening a stuck or ‘drop’ foot.
Lesley, from Walsall, suffered her stroke in November 2008. ‘One day I tried to get up off the sofa and couldn’t move,’ she says. ‘I tried to speak and slurred my words. Then I collapsed.’
She was rushed to hospital, where an MRI scan revealed a huge blood clot on the right side of her brain. ‘I had no power in my legs and had to be spoon-fed puree,’ she says. ‘I was terrified.’
Three weeks of intensive physiotherapy in hospital taught her to take tentative steps on her own. But life was far from normal.
‘I’d fall asleep from the exhaustion of walking,’ she says. ‘There was no way I could go back to my stressful job running a wine bar.’
The following September she developed an irregular heartbeat and was prescribed warfarin. But neither that, nor weekly physio, made much improvement.
In early 2010, Lesley began to despair when she developed dystonia – constant spasming of the muscles. ‘I lost control over my left arm,’ she says. ‘The pain was intense. It travelled down my arm from my shoulder and stopped me sleeping. My arm was permanently clenched into my body and my left hand was like a claw. If I did manage to hold a glass, I would smash it as I had no control.’
In May 2010 she was prescribed Botox by her doctor, Poovathoor J. Alexander, Consultant Physician in Neurological Rehabilitation for Walsall Healthcare Trust.
He explains: ‘It blocks the release of a chemical called acetylcholine from the nerve, which stops the muscle contracting.
‘It starts to work within four to seven days, reaches its peak function within six weeks, and should last at least four months.’
Lesley was given eight 1mg jabs – four in her biceps and four in her forearm. She found the injections ‘incredibly painful’ but, unlike other drugs used for stroke, Botox doesn’t have any known side effects on the liver or kidneys.
Dr Alexander says Botox can actually improve muscle function. ‘It must be used in conjunction with physiotherapy to stop the muscles getting stiff,’ he says. ‘It relaxes the muscle injected so it is easier to stretch it. Lesley had a splint to keep her fingers stretched.
‘Each treatment costs up to £1,000, and hopefully Lesley will eventually be able to lead a normal life without it, but it’s difficult to say how many courses a patient will need.’
Lesley still has Botox every six months and is now well enough to take a degree at Coventry University. She says: ‘It’s made an incredible difference. My arm muscles stopped spasming and it was wonderful being able to uncurl my hand. Best of all, the pain stopped, I’ve got my confidence back.
‘There was a time I thought I’d never lead a normal life but thanks to the Botox I’m happy again. I don’t want to build up a dependence but as long as it keeps being effective I’ll carry on having it.’