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Oregon Road Conditions & Cams Email Story to a Friend December 21, 2005 Dr. Cornelia Byers tests Bill Thomas� arm for involuntary resistance. Byers uses botulinum toxin to reduce excessive muscle �tone� that is often associated with spinal injuries like the one Thomas suffered during an accident. Denise Baratta photo New wrinkle for a killer Poisonous botox is used to help patients whose muscle ‘tone’ is too great By BILL KETTLER Mail Tribune A deadly poison helps Bill Thomas live a fuller life. The Merlin man nearly died in a motorcycle wreck in June 2004. When he survived, physicians thought he would be paralyzed from the neck down. He surprised everyone when he regained the use of his arms and legs. Some of his limbs still have a mind of their own — a knee that won’t straighten, a shoulder that won’t rotate. The culprit is what physicians call "tone," the natural tension in muscles that makes them feel firm. Thomas has too much tone in some muscles. They won’t "let go" to allow the opposing muscles to do his bidding. "He has tone he has to fight all the time," says Dr. Cornelia Byers, Thomas’ physician and the medical director for Providence Regional Rehabilitation Center. Byers uses botulinum toxin to relax muscles with too much tone. It’s the same "botox" that gained fame in recent years among people looking for a way to erase facial wrinkles. Advertisement "Tone can lock the limb," Byers says. "We can inject botox selectively into the muscles that are the culprits." When the tight muscles relax, Thomas can work at bringing them back to normal. A physical therapist helps him gain strength and rebuild the natural balance between opposing sets of muscles. "My left arm just hung there for the longest time," he says. "With the botox, now I can use my hand for typing." Excessive tone (also known as spasticity) is frequently a problem for people who suffer from multiple sclerosis or cerebral palsy. It also occurs after a stroke or a traumatic injury to the brain or spinal cord. Spasticity can make the activities of daily living difficult and uncomfortable. Everyday chores such as dressing, bathing and eating become time-consuming and frustrating. Left untreated, spasticity can lead to serious health problems. Muscles may grow permanently shorter, making joints impossible to move. Muscle relaxants and other oral drugs have too many side effects (such as drowsiness, nausea and confusion) to be used to reduce tone. By injecting botox directly into the offending muscles, physicians bypass the brain and a whole range of side effects. Byers has used the toxin on a number of patients over the years, including a 6-year-old girl with cerebral palsy. The girl could not use her hand because of excessive tone in muscles that controlled the thumb. Byers relaxed one small muscle with botox, and the girl regained use of her hand. While the toxin has remarkable power, Byers cautioned that it is not a panacea. It requires several days for most people to feel a change, and its efficacy diminishes after several months. Many people must be treated repeatedly, and there is no guarantee that botox will overcome excessive tone. It’s also expensive, even in small doses, and physicians use relatively large amounts to relax big muscles. One treatment can easily cost hundreds of dollars, depending on the number of injections that are required. Physicians must also use extreme care with botox because it can be fatal in large doses. Byers has to monitor how much toxin each patient receives, and if too many muscles need to be relaxed, she must look for another way to relieve tone to avoid any risk of overdose. For cases like those, Byers often uses a yo-yo-sized pump that is filled with baclofen (a powerful antispasmodic) and implanted in a patient’s abdomen. A thin tube carries the drug from the pump to the space around the spinal cord, where it is dispensed directly to the nerves, avoiding all the side effects associated with taking baclofen orally. The pump can be refilled periodically and the dosage can be programmed from outside the body. "It’s like a dimmer switch," Byers says. "You adjust it for the appropriate dose." Thomas looks forward to the day when he’ll be able to move normally and the constant tingling in his fingers will disappear, but he knows fortune has been kind to him. "I’m very lucky," he says, "for a guy who’s not supposed to be walking." Reach reporter Bill Kettler at 776-4492, or e-mail New wrinkle for a killer ">[email protected] . Mail Tribune Home | Local News | Sports | Business | Obituaries | Life | Opinion AP News | Archives | Site Map | Community | Classified Copyright © 1997-2005 Mail Tribune, Inc. All rights reserved. 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