Botulinum toxin injections

This page explains about injections of a medicine called botulinum toxin. It also tells you what to expect when you come to Great Ormond Street Hospital (GOSH) for the injections.

Botulinum toxin A is a medicine which helps to relax stiff muscles.

Stiff muscles may make it hard for you to move. The medicine helps the stiff muscles to relax which may help you to move more easily. It will also give a chance for your other muscles to work.

You will have some special cream put on your skin to make it numb. You will also take some medicine which will make you sleepy. When you feel relaxed, the botulinum toxin medicine will be given to you by an injection into the stiff muscle or muscles.

You will be seen at GOSH two weeks before injection day. At this appointment, you will see a physiotherapist and doctor. They will see how much you can move your arms and legs, and sometimes they will video the way you move or walk. At this appointment we will decide together which muscles to inject.

On the day of the injections, you can have an early breakfast. You should stop eating and drinking after this – the team will let you know the exact time. You will get to the hospital in the morning and when you arrive, you will be given a bed, and meet the nurses who will let you know what will happen next.

When you have settled in on the ward, the doctors and physiotherapists who you may have already met in the clinic will come to say hello and see how you are.

They will then put special cream over the muscles they will inject so that the skin is numbed. To find the right place to put the cream, they will use an ultrasound machine, which does not hurt. To help see the muscles better, they use a gel which will feel a bit cold. When they find the right place, they mark it with a dot, and then put on the cream. The cream will be kept in place by a special plaster.

You can then go and play while the cream works. After an hour or so, you will take some medicine to make you feel relaxed. When you feel sleepy, you and your parents or carers will go into another room with the same doctors and physiotherapists to have the injection(s).

When you feel more awake, you can have something to eat and drink. You might feel a bit sleepy for a while afterwards but this will wear off after a few hours.

Once you’ve eaten and you’re feeling fine, you can let the nurses know that you’re ready to go home. When you get home, you might feel a bit sore where the injections were given. You can take paracetamol if you feel unwell. You should feel fine again the next day.

As the botulinum toxin medicine starts to work, your muscles will start to relax. This may make you feel a bit wobbly at first. This will get better, but tell someone if you are worried. For the next few months, work extra hard on your exercises and stretches as this will help the botulinum toxin medicine work even better.

You will come back to see the doctors and physiotherapists twice after the injections to see if the injections have helped.

If you want to know more about the injections, you can ask your doctor or physiotherapist.

Last reviewed by Great Ormond Street Hospital: April 2015.
Ref: 2012C0134 © GOSH NHS Foundation Trust April 2015
Compiled by the Movement Disorder Team in collaboration with the Child and Family Information Group.