Botox Injections for Spasticity and Sialorrhea

Abstract

In patients with cerebral palsy, injections of botulinum toxin type A (Botox) into muscle groups to reduce spasticity may decrease spasmodic pain and improve movement by increasing range of motion, thereby facilitating care and potentially lessening contracture development. This procedure requires little time but is painful, and repeated treatments are necessary. The level of sedation used for this procedure varies among institutions and from patient to patient, ranging from no sedation at all to general anesthesia. Minimal to moderate sedation with nitrous oxide is an effective method of sedation for this procedure. The sedationist must be prepared to handle complications such as emesis and aspiration. Injection of the submandibular and parotid glands for sialorrhea is a growing indication for Botox injection; deeper levels of sedation are required for sialorrhea than for spasticity to allow localization of the gland and precise delivery of the treatment.