Neurology - EMG Guided Botulinum Toxin Injections

Before the procedure

You may have been referred to the clinic by a consultant in another department who has discussed the various treatment options for your condition and feels that botulinum toxin injections would be the most suitable.

If you feel that you would like more information before making a decision on this treatment then please speak to your consultant or ask the consultant when you come for your test.

A consultant neurophysiologist/consultant neurologist will talk to you about your symptoms and then discuss with you whether botulinum toxin injections will be suitable, this may also involve taking a medical history and examining you.

A decision will be made on the site and number of injections required. You will be asked if you are taking any medication, so it would help if you bring a list of your tablets with you to the appointment.

In particular you will be asked if you are taking any blood thinning medication (anticoagulants) please let your consultant or specialist nurse know as special precautions need to be undertaken. These includes: Warfarin, Dabigatran, Apixaban, Rivaroxaban.

Botulinum toxin is not suitable treatment if you are pregnant, breast feeding or ‘trying’ for a baby. You will have the opportunity to ask questions before you decide whether to have the treatment.

How does the treatment work?

Botulinum toxin works by weakening the muscles affected by the spasms and repeated injections are often needed for continued relief.

During the procedure

The procedure is performed in the clinic and takes approximately 5 to 10 minutes. You will be reclined on a couch or seated in a chair for the injections. The botulinum toxin will be injected into the muscle using a fine needle, this is usually connected to a machine which records activity from the muscles to help decide which muscle to inject, this is called EMG guided injection.

You will feel a sharp scratch when the needle is inserted. The exact dose given will vary depending on which muscles are injected and may be changed depending on your response to previous injections.

The botulinum toxin will usually start to work within 7 to 10 days of the injections and last for 2 to 3 months, you should start to notice it wearing off 2 to 3 weeks before your next appointment.

After the procedure

• Most people will be able to return home and back to normal activities immediately after the injections
• Try to avoid rubbing or touching the site that has been treated
• Before you leave clinic, you will be given details of your next appointment. This is usually in 3 to 4 month's time

Possible side effects of the botulinum toxin injections

The injections are usually very well tolerated, but side effects can sometimes occur. If you do experience side effects, then they will usually wear off in a few days or weeks.

Potential side effects include:

• Occasionally bruising or tenderness may develop around the injection site. In rare cases the limb may bruise badly or swell (this is almost only seen in people who are on blood thinning medications (heparin, warfarin or sinthrome). If this happens you should go straight to the Accident and Emergency department
• Sometimes the muscles around the site of the injection become weaker than expected, this excessive weakness will resolve over a few weeks as the effects of the toxin are only temporary
• Botulinum toxin contains human albumin which comes from blood. As with any medicine which is created from human blood there is a possibility of passing on infections. To reduce this risk blood donors are chosen very carefully. Furthermore, botulinum toxin is made in a way that should remove or destroy viruses. This may be of importance to Jehovah’s witness’ when considering treatment
• On rare occasions flu like symptoms, headaches, fever and tiredness may occur
• Occasionally patients can develop antibodies against the toxin. Antibody formation is more likely to happen with high doses or with intervals of less than 12 weeks between doses. If antibodies develop then the botulinum toxin may no longer work

Is there anything else I should know?

Please arrive in good time for your appointment. If you think you will be late, please telephone us as soon as possible. It may be necessary to re-book another appointment for you.

Parking can be difficult, please allow for this. There is a charge for car parking.

You may eat and drink normally before your test. Please note there are no facilities for childcare while you are having your test.
If you are taking any medication you should continue to do so unless otherwise advised by your own GP or consultant.

If you require an ambulance, you should contact your own GP to make the arrangements. Please let us know if you will be coming by ambulance.

Information and support

If you have any questions or anxieties, then please feel free to discuss them with the consultant or dystonia nurses.

Dystonia Nurses

Diane Ashton
Telephone - 0161 206 2562
Email - diane.ashton@nca.nhs.uk

Jemela Danjuma
Telephone - 0161 206 5100
Email - jemela.danjuma@nca.nhs.uk

Dystonia UK
Telephone - 08454586322
Website - www.dystonia.org.uk
Or for the local branch telephone Chris Smith on 08458997131

Contact details
Department of Clinical Neurophysiology
Manchester Centre for Clinical Neurosciences
Barnes Building
Salford Royal Hospital
Stott Lane
Salford, M6 8HD
Telephone - 0161 206 2068