Botox Injections

Cervical Dystonia or Spasmodic Torticollis

v-patient1.jpgCervical dystonia, also called spasmodic torticollis, is a chronic, often painful neurological disorder. It is a movement disorder – a condition that is characterized by loss of control over one or more parts of the body. Although it affects approximately 125,000 people in the United States, very few people know what it is!

Cervical dystonia is characterized by involuntary contractions of the neck muscles. This causes twisting, repetitive movements, or abnormal postures of the head. These muscle contractions hinder normal movement and can cause severe, chronic neck pain. The mean age for symptoms to appear in patients with cervical dystonia is approximately 41 years. However this condition may occur in all ages – and women are twice as likely to be affected as men. The symptoms of cervical dystonia usually develop gradually over a period of time, with the most severe symptoms developing within about five years. These symptoms can include painful contractions of the neck muscles that force the head to move forward (anterocollis), backward (retrocollis), sideways (laterocollis), or to twist to the left or right (torticollis). The neck spasms experienced by patients with this disorder may be constant or intermittent. This constant muscle activity is often very painful.

Although there is no cure for cervical dystonia, injection of therapeutic doses of BOTOX® (onabotulinumtoxinA) neurotoxin into the neck and shoulder muscles is a commonly chosen treatment in adults to treat the abnormal head position and neck pain that happens with cervical dystonia. The effect is temporary and the treatment can be re-administered approximately every three months depending on the individual patient. In severe cases, surgeries in which either the nerve to the contracting muscle is cut or a section of the muscle itself is removed are recommended in patients who do not respond to less invasive therapy.

Physical therapy is recommended in nearly all patients with cervical dystonia to help ease the severity of contractions. Stretching exercises and neck braces have been shown to ease the severity of contractions and are recommended in addition to medication and/or other therapies.

Physiatrists are highly skilled in administering Botox injections for cervical dystonia.

Upper Limb Spasticity

Upper Limb Spasticity is a condition in which certain muscles in your body become stiff or tight. This happens when the brain over communicates with these muscles, constantly telling them to contract, or tighten. If you or your loved one has stiffness in the muscles of the elbow, wrist, or fingers in conjunction with certain conditions, it could be a problem called upper limb spasticity. There are various conditions that can cause upper limb spasticity. They all share a common factor—damage to a portion of the brain or spinal cord. Injury can cause the brain to constantly tell the muscles to contract, making them tight and stiff.

Upper limb spasticity can occur as a: 1) Bent wrist – The wrist is usually bent with the fingers pointing down and back toward the forearm. 2) Closed fist - Fingers are tightly clasped into the palm of the hand. 3) Tight arm twisted against the chest 4) Stiffening or tightening of the wrist and/or arm 5) “Catching” feeling in the arm during a quick movement

Upper limb spasticity can result from several distinct conditions, such as:

1) Stroke - A stroke can damage small parts of a person’s brain, resulting in speech and/or vision problems and movement problems such as paralysis. These issues usually happen within a year after the stroke.

2) Multiple sclerosis (MS) - In MS, the cover of the nerve cell fibers in the brain and spinal cord—called the myelin sheath—gradually wears away, resulting in loss of movement, pain, and upper limb spasticity. Symptoms of MS can worsen and improve in cycles.

3) Adult cerebral palsy - The symptoms of cerebral palsy appear in childhood and can persist in adults, affecting movement and coordination. It is not the result of damaged muscles or nerves, but rather problems in the part of the brain that controls muscle movement. As with a stroke, the damaged part of the brain can also cause reduced arm function associated with upper limb spasticity.

4) Traumatic brain injury (TBI) - Upper limb spasticity can occur within days of a traumatic brain injury due to the extreme stress of a violent impact or skull fracture.

5) Spinal cord injury (SCI) - After SCI, the nerve cells that control muscle activity below the injury become disconnected from the brain. As a result, upper limb spasticity is common after trauma to the spinal cord.

Physiatrists are highly skilled in giving Botox injections for upper limb spasticity.

Chronic Migraine

Chronic Migraine is a severe neurological disorder impacting an estimated 3 million or more Americans. Patients with this condition suffer from headaches on 15 or more days per month with headaches lasting four hours a day or longer. BOTOX® is the first clinically studied treatment to be approved by the FDA specifically to prevent migraines for this debilitated patient population. The injections are given every 12 weeks to chronic migraine sufferers.

Women are three times more likely than men to suffer from migraines, although men suffer as well. Depression and anxiety are often found as part of the condition. Chronic Migraine is often influenced by stress, sleep habits, diet, and overuse of acute medications taken to relieve the pain associated headaches.

Approximately 80 percent of those who meet the definition of Chronic Migraine have not received an accurate diagnosis and, as a result, may be unaware of their treatment options.

Dr. Bernal is skilled at providing Botox injections for the treatment of chronic migraine.