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Botulinum Toxin: How Botox Injections Help Treat Children with Cerebral Palsy and other Neuromuscular conditions

Botulinum Toxin: How Botox Injections Help Treat Children with Cerebral Palsy and other Neuromuscular conditions

by | Sep 15, 2023 | Pediatric Developmental Disabilities

At Scottish Rite for Children, our experts in Neurology and Rehabilitation Medicine care for patients with cerebral palsy using a variety of treatment methods. Treating the symptoms of CP can take many forms, and one common treatment for spasticity, or abnormal muscle tightness and stiffness, is the use of botulinum toxin (BT) injections. Known under name brands like Botox or Dysport, pediatric physical medicine and rehabilitation physician Fabiola I. Reyes, M.D., shares what parents need to know about this treatment.
 
What are botulinum toxin injections?
Botulinum toxin type A is a substance produced by the bacteria Clostridium botulinum. While toxic when ingested orally, the substance can be purified and safely injected locally in muscle tissue to treat a variety of conditions, including spasticity. It can be formulated in different ways and comes manufactured under different brand names like other pharmaceutical drugs.
 
How long has it been around?
BT injections have been used for patients with cerebral palsy for about 25 years. It was approved by the Food and Drug Administration in 1989 for eye conditions and muscle spasms in the face but has since been studied and approved for use with several other neuromuscular disorders.
 
How does it work?
Spasticity can make moving difficult, cause pain, loss of sleep and interrupt daily living activities due to the involuntary muscle tightness. When injected, BT injections work by blocking the chemical signal between nerves and muscles that cause contracting and tightening of the muscles. This can help relax muscles in the area around the injection site, although the effects are not permanent.
 
Is it safe?
BT injections have been used to safely treat spasticity in patients with cerebral palsy for more than 25 years. BT injections have been studied extensively by doctors and researchers all around the world and is approved to treat a variety of conditions and is even used for cosmetic purposes to prevent wrinkles.
 
BT injections were approved to treat spasticity in children with cerebral palsy in 2019. The safety and efficacy of the treatment has been backed by studies and trials in children ages 2 to 17 years.
 
Why use it for treatment?
In patients with cerebral palsy, BT injections have been found to improve range of motion, gait pattern, joint positioning and stability while reducing pain in the muscles, spasticity and tension.
 
BT injections are easy to administer, and the procedure can be performed in an outpatient setting. When giving injections, the provider will identify the muscles that need to be targeted. Multiple injections may be required for larger muscles or muscle groups, but the actual injection procedure only takes a few minutes.
 
How often does it need to be done?
Typically, BT injections prevent muscle tension in the injected areas for about three months, after which the effects may begin to decrease. The length of efficacy will differ for each patient.
 
What are the side effects?
The side effects of BT injections are minimal. The most common side effects are temporary weakness and injection site pain, but these effects occur in less than 10 percent of patients.
 
Learn more about our care for children with cerebral palsy.
Get to Know our Staff: Sandra Hatchel, Inpatient Nursing Unit

Get to Know our Staff: Sandra Hatchel, Inpatient Nursing Unit

by | Sep 6, 2023 | Spotlight

What is your job title/your role at Scottish Rite for Children? 
I am a registered nurse on the Inpatient Unit.
 
What do you do on a daily basis or what sort of duties do you have at work?
As a R.N., I am kind of a jack-of-all-trades. I do all the tasks needed to provide care for my patients and their families while trying to provide the best experience possible.
 
What was your first job? What path did you take to get here or what led you to Scottish Rite? How long have you worked here?
My first job was as a vet assistant – I learned fast that while I liked dogs, this was not for me. When I started out in college, I volunteered at a local hospital. I found nursing interesting and thought, ‘Yep, this is where I’m meant to be.’ Since that time, I’ve worked as a tech for 10 years, then became an L.V.N., then R.N., (with both an associate degree in nursing and Bachelor of Science in Nursing). I basically just keep upgrading.
 
A fellow R.N. buddy worked at Scottish Rite and loved it. They said it was a different environment than other places to work. She was right — the work environment is just a different vibe — hard to describe, but if you know you know. I had always considered working in pediatrics and have been here for the last 2½ years.
 
What do you enjoy most about Scottish Rite?
I love my fellow tight-knit band of coworkers. We are like family! We know how to lift each other up and are always willing to help out or answer any questions. Every day I learn something new.
 
Tell us something about your job that others might not already know?
I am a nurse, and a lot of people have an image of what that entails because what they see on TV, but the reality is not really like that. As a nurse, you are the advocate/cheerleader/friend/rule maker (the list goes on and on), but we truly are there for every up and down in our patient’s and family’s lives. It is awesome to see a kiddo who has been on the unit for a while go home, because you know you helped them get to that place of recovery. Our kiddos are very strong and some add a little sassiness to the mix. I love it!
 
Where is the most interesting place you’ve been?
Well, I have not done a lot of traveling outside of the U.S., but I would love to travel to Ireland and Spain. My dad is of Irish decent, and it would be nice to visit the beautiful country sides.
 
If you could only eat one meal for the rest of your life, what would it be?
Easy — tostadas or enchiladas! Well, anything TexMex. Yum!
 
If you could go back in time, what year would you travel to?
I would go back to the ‘80s era. It was my childhood and an awesome time.
 
What three items would you take with you on a deserted island?
A book, comfy clothes and some tea bags (I love unsweet tea – if you know me, you know this is true!)
 
What’s one fun fact about yourself?
I have a crazy sense of humor mixed with a little sarcasm. Even in the worst of times, we need to laugh. 
Coaching Kids: Top Tips for Coaches

Coaching Kids: Top Tips for Coaches

by | Sep 5, 2023 | Sports Medicine

Here are simple tips to integrate into coaching messages for kids. Building a solid foundation of good habits will help them well-beyond this youth sports season.

  • Teach athletes to eat a healthy snack with carbs before games and practices.
  • Encourage athletes to drink water before, during and after practice and games.
  • Respond quickly to complaints of pain and encourage an evaluation by a pediatric sports medicine specialist.
  • Learn how to lead your team through a dynamic warm-up and save stretching for after games and practices.
  • Most of all, keep it fun!

As a participant in the University of North Texas Athlete Transition Program, Tyree Eady, B.S., M.S., volunteered at Scottish Rite for Children in the Movement Science Lab on the Frisco campus. He is passionate about changing the future for young athletes through research and using his platform as a professional athlete

Learn more about sport-related injury prevention.

Share Your Story: Connor’s Comeback

Share Your Story: Connor’s Comeback

by | Sep 1, 2023 | Scoliosis & Spine

Meet Connor, a strong and determined athlete whose journey with Scottish Rite for Children began when he was just 10 years old. His scoliosis was first noticed by his mom when she noticed his clothes hung differently. She asked his pediatrician, who referred them to Scottish Rite spine experts. Visiting Chief of Staff Dr. Dan Sucato, Connor’s scoliosis was identified as a 30-degree curve at the time, prompting regular monitoring every six months.

As Connor grew and got more into school sports, his scoliosis curve increased too. His curve was 60 degrees, causing him discomfort. Frustrated with the limitations his condition imposed, Connor decided at 15 that he was ready for a change and opted for surgery.

Last summer, Connor underwent spinal fusion surgery. He spent three nights recovering in our inpatient unit. The support he received from our medical team eased his worries, making him feel at ease about the surgery. His quick recovery amazed everyone, allowing him to celebrate his 16th birthday with friends just two weeks later.

The transformation was remarkable. His shoulders were even, and his T-shirts fit properly. His dedication to recuperation and determination to regain his active lifestyle paid off. With his scoliosis corrected, Connor joyfully rejoined the high school junior varsity football team and played in his first game after taking a year off.

But it wasn’t just the surgery. Connor found comfort at Scottish Rite, from our yummy popcorn to our caring staff who he says felt like family to him. Dr. Sucato didn’t just fix his scoliosis; he brought back normalcy. With no more limping due to his hip pain, Connor got his life back. He’s loving football, golf, hiking and rafting. Watching sports and eating out with friends now brings him joy, as he embraces his new freedom without limitations.

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.

Share Your Story: Bria’s Big Break

Share Your Story: Bria’s Big Break

by | Aug 25, 2023 | Sports Medicine

Bria is a 12-year-old girl who stays busy with a variety of activities. From cheerleading, playing on her trampoline, hanging out with her friends and swimming, she is always on the move. After being diagnosed with Osgood-Schlatter disease, a condition that causes inflammation of the patellar ligament and creates a painful bump just below the knee, Bria and her family came to the Scottish Rite for Children Orthopedic and Sports Medicine Center for treatment. Bria’s mom, Krista, shares their experience in this Share Your Story:

Written by mom – Krista Cardenas

We came to Scottish Rite for Children’s Center for Excellence in Sports Medicine a few years ago for treatment of Osgood-Schlatter disease in Bria’s knee and various cheer-related aches and pains. We really loved Stephanie De Jager, M.S.N., CPNP, and she became our go-to “person” when Bria had injuries.

Last year at an open gym one evening, Bria was tumbling and broke her tibia and had emergency surgery at another Dallas hospital. She fractured it through the growth plate and had compartment syndrome to make things worse. Once she was finally discharged, as the mom, I fell apart when we got home. I didn’t have our “people” to tell me everything was going to be ok, so I called Stephanie. She called me and talked to me at length, reassuring me that we could always switch and follow up later at Scottish Rite. We tried to give the other hospital a chance, but our heart was at Scottish Rite.

At our follow up, their plan of care was hasty, and they didn’t listen to me in discussing her projected growth before scheduling surgery, so we transferred Bria to Scottish Rite for further care. Thank goodness we did, because we got to meet Dr. Ellis, and we absolutely adored him. He really listened and took the time to look at Bria’s realistic growth based on our family heights and her puberty. We watched and waited for almost a year, and each appointment he was conservative and not quick to operate.

Finally, almost a year later, we pulled the trigger and had to do some growth plate modification for limb inequality and to correct a valgus. Our experience was completely different from the first surgery at the other facility. They took the time to explain at length every detail and answer all my million questions, never judging me for my hesitation. Child life specialist Marissa Willis sat with Bria and acknowledged the trauma of her first experience last year. She reassured her that this would be so much different, explaining every step she would experience on surgery day.

Finally on surgery day, we were impressed by every single person we encountered. From Nancy at the desk with her calming and friendly personality, to the volunteer cooking up fresh cookies and tending to my son and Bria’s grandfather, to each nurse we encountered having a kind and reassuring demeanor. Everyone put us so much at ease that we as a family were completely confident in sending her off. We really appreciated Falco’s visit, and he went straight to Bria’s dad to put his head in his lap because Dad was the most anxious. Wow! What an amazing dog! The facility was impeccably clean, updated and everything was so organized.

I can’t say enough about how amazing Scottish Rite is, and we will forever sing your praises. My husband and I both said we want to work at Scottish Rite! Bria’s grandfather couldn’t stop talking about how impressed he was with the facility. He kept saying, “This place is FIRST CLASS!” From the smell of popcorn the moment we walked in, to the kind nurses helping her into the car, this day could not have been any more perfect (for a surgery day that is!).

Learn more about our Center for Excellence in Sports Medicine.DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.