Newspaper article: How Botox can help Stroke victims

How Botox can help stroke victims  by PAT HAGAN, Daily Mail

One of the most deadly poisons known to man has been turned into a radical new treatment that could benefit thousands of stroke victims. Botulinum toxin, or Botox, is so dangerous in high doses that it can kill by paralysing the body's muscles.

But scientists have now discovered that injecting minute quantities of the poison can help stroke victims regain movement and control in their arms and hands.

Doctors estimate the breakthrough could help at least 5,000 stroke sufferers a year who are left with a condition called limb spasticity - when muscles in the arms and legs become overactive, often going into spasm and causing pain and deformity.

A licence for doctors to use the toxin is expected to be granted in the UK within the next few months. Strokes, which are caused by a blood clot in the brain, are the third biggest killer in the UK, trailing behind only cancer and heart disease.

Every day in the UK, nearly 200 people die from a stroke and thousands more are left disabled. The number of new cases each year stands at around 100,000; it costs the NHS £2.3 billion a year to treat and look after stroke victims.

Limb spasticity is one of the most common side-effects of damage to the brain and spinal cord. In the legs, it can affect the patient's movement and walking ability, while in the arms and hands it can affect grip and make it difficult to bend the elbow.

The over-activity in the muscles makes them contract and stay that way for prolonged periods of time. Eventually, this leads to shortening in the soft tissue around the muscle and means the affected arm or leg can become permanently deformed.

Although drugs can treat the disorder, most have unpleasant sideeffects. Doctors estimate that around 40 per cent of patients treated are unable to tolerate the drugs used, and while surgery is an option for some people, the results have been inconsistent.

Now it's hoped that by injecting botulinum toxin directly into the affected muscles, doctors may be able to help many more patients. The poison blocks the release of acetylcouplecholine - a chemical that transmits the signal telling muscles to contract.

It has already gained a reputation as an unlikely remedy for a range of health conditions - from back pain and Parkinson's disease to excessive sweating and crow's feet.

But the latest breakthrough could open up the toxin's benefits to a much bigger group of patients.

Doctors from the UK, Germany and the Republic of Ireland looked at the effects of Botox on a group of stroke victims as part of an international trial.

Half the patients were given a Botox jab and the other half a dummy injection. The change in their wrist and finger movements was then measured.

The results, published in the European Journal Of Neurology, showed a marked improvement in the botulinum group which lasted at least four months after the injection.

Loralei Hurd, an 18-year-old student from Hemswell Cliff, near Lincoln, was one of the first patients in the UK to benefit from the controversial treatment.

At the age of eight, she fell off a tricycle at school in California and hit her head. Eight hours later she collapsed with a blinding headache and was unable to talk, walk or use her right arm or leg.

A brain scan showed she had suffered a stroke - probably as a result of the accident - and although Loralei was able to walk again within a week, her speech was slurred and her face drooped. Her right arm was almost useless.

'About a month after the stroke, I went back to school and that was the worst day of my life. I suddenly found that from being top of my class in every subject, I was unable to write a simple sentence or add two and two. The doctors hadn't prepared me for this and I was devastated.'

A year later, Loralei moved to England - where her father is from - but had to struggle through school to achieve five GCSEs.

'My right arm was still pretty much useless, my hand tended to grab hold of things and not be able to let go. This could be embarrassing when shaking hands with people, and dangerous if I took hold of an escalator rail.

'Once, on the school bus, I missed my stop because my hand would not release from the rail coming down the stairs.'

Then Loralei's GP referred her to the local stroke rehabilitation clinic, where doctors suggested injecting botulinum toxin.

Within two days of having a of jabs, she started to see the benefits. 'My hand started to relax and with physio, I was soon able to move,' said Loralei.

'I was working as an assistant in a clothing store to earn money to pay for college and the difference it made was incredible. Several times I cried with happiness.'

Stroke expert Dr Anthony Ward, from the North Staffordshire Rehabilitation Clinic in Stoke-on-Trent, said there are huge advantages to using Botox.

People who have strokes often have high blood pressure or diabetes,' he said. 'But botulinum toxin is one of the few treatments that has little or no interaction with other drugs.

'Many of the drugs we use for spasticity in strokes often have a quite marked effect on the liver and kidneys, but this is really very safe.

'It takes about one week to work and the effects last for around three months.' Dr Ward stressed the toxin must be used in conjunction with other treatments - such as rehabilitation therapy - and warned doctors they must stick to guidelines drawn up last year by a panel of experts.

Although the treatment is expensive, doctors predict there could be massive savings in reducing spending on follow-up care for stroke victims.

And as far as Loralei is concerned, it's worth every penny. 'Last time I also had an injection in my right leg and that helped, too - my toes don't cramp up in my shoes.

'Try walking around with your toes scrunched up in your shoes for a while and you'll understand how good it feels when that doesn't happen.'

 

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