Mel could hardly use her hand after a stroke at just 15, but Botox jabs are unlocking her muscles
22:30 GMT, 24 September 2012
Mel Strzebrakowska was just 15 and celebrating her father’s birthday at home when she suffered her stroke.
She remembers nothing about that day apart from waking up in intensive care.
‘I tried to scramble out of bed, but my legs collapsed, and my right hand wouldn’t work either,’ says Mel, now 24, a retail assistant from Warlingham in Surrey.
On suffering a stroke at 15: 'I couldn't take it in. I was so young. I couldn't believe it had happened to me,' said Mel Strzebrakowska
‘I didn’t know what was wrong. Then the doctors told me I’d had a stroke.
'I couldn’t take it in. I was so young. I couldn’t believe it had happened to me.’
Every year around 150,000 Britons suffer a stroke, where either a blockage in the blood supply deprives the brain of oxygen, or a bleed in the brain causes damage to nerve cells and function.
Risk factors include high blood pressure, diabetes and heart disease.
In Mel’s case the cause was more unusual: her stroke was due to an arteriovenous malformation — an abnormal connection between an artery and a vein in the brain.
Although she’d already been diagnosed with this, unfortunately the malformation was so deep that surgery was too risky.
The stroke left Mel weak down the entire right side of her body.
She was unable to walk, and she also struggled to speak.
When she left hospital three months later, on Christmas Eve, she still needed a wheelchair and faced months of physiotherapy and occupational therapy as she learned to walk and talk again.
The good news was that in October the following year, she was able to have radiotherapy to seal off and shrink the malformation in her brain.
Yet even then she was still suffering the lasting effects of the stroke: her right side remained weak and she couldn’t open her hand, which was clenched into a fist.
So Mel had to learn to write with her left hand. Washing, opening a door, even holding on to a bannister or escalator rail were difficult with her right hand because her grip was so tight.
Up to 30 per cent of stroke survivors suffer this muscle stiffness, known as post-stroke spasticity, which means they have abnormal tightness in some of their muscles.
The Botox treatment helped loosen Mel's right hand
While doctors don’t fully understand why this happens, it is thought that the nerve pathways from the brain which control and normally reduce this muscle tightening have been damaged.
Drugs that relax the muscles can treat the disorder, but many have side-effects and around 40 per cent of patients cannot tolerate them.
With the help of speech and language therapy and rehabilitation therapy, Mel learned to walk and talk again.
She returned to school and university, then started a job in a supermarket.
The only lasting legacy was her clenched right fist.
So, four years after her stroke, Mel also started having injections of Botulinum toxin, or Botox, which are often used to treat post-stroke spasticity.
The poison blocks the release of acetylcholine — a neuro-transmitter that sends the signal from the brain telling muscles to contract.
‘The problem with medication is that the drugs are usually taken orally, so they affect the whole body and brain and can thus cause drowsiness, while Botox targets the stiff muscles directly and does not have these systemic side-effects,’ says Dr David Werring, a consultant neurologist and clinical senior lecturer at University College London (UCL).
The Botox treatment helped loosen Mel’s right hand, but the effects lasted for only a few months before her fist would tighten again. She had to travel to London every three to six months for the injections.
‘It was time consuming, but I tried not to get frustrated because I knew they were trying to help me,’ she says.
Mel continued the Botox treatment for five years.
Then, in 2010 when she was 22, her doctors at UCL mentioned a new study they were doing, combining Botox with regular, targeted physiotherapy sessions.
It was hoped this would have a longer-term effect on tightened muscles in those with post- stroke spasticity.
Dr Werring, who is leading the study, says: ‘We know that Botox has a temporary muscle-weakening effect of up to three months, and by combining it with physiotherapy we hope to create a window of opportunity so that the stroke survivor and their physiotherapist can work on those muscles and create a longer-lasting effect.’
The trial, funded by the Stroke Association, is giving participants with post-stroke stiffness in their hands injections of Botox or a placebo combined with physiotherapy to measure the effect on hand function.
Mel joined the trial, continuing to travel to London for injections every three to six months, and then having two-hour physiotherapy sessions every week.
She was also given lots of exercises to do at home, including muscle stretching and strengthening exercises.
She does not know at the moment if she has had the Botox or the placebo, but she suspects the former because gradually she has regained control of her right hand.
‘I can wash much more easily, and as well as gripping things I can just let go,’ she says.
‘Opening doors and jars is so much easier, and I can even hold and release small things like money when I’m on the till at work.’
The doctors will not know the results of the trial for another 12 to 18 months, but Dr Werring says early reports from patients are encouraging.
‘Some participants are already reporting real benefits — this is really exciting,’ he says.
‘Botox will not help all stroke survivors regain hand function, since many have muscle weakness which it cannot treat.
'But in some stroke survivors with spasticity in their fingers or wrist, and some preserved muscle strength, this treatment is promising.
‘And unlike muscle relaxant medications, including drugs like baclofen or tizanidine, Botox is very safe because it just targets the site of the muscle problem, and is temporary.’
Dr Peter Coleman, deputy director of research for Stroke Association, says: ‘We are very excited about this study.
'We are always looking for new ways to help stroke survivors adapt to their life after a stroke and recover as much movement as possible.
‘If the treatment proves to be effective, it could help thousands of stroke survivors recover some movement in their arms and hands, enabling them to regain some of their independence and improve their quality of life.’
‘The physio sessions make a load of difference,’ she says.
‘Without the treatment, my hand is stiff and I can’t use it properly.
‘Now, at last, I can use my right hand again, and can wash and grip and release small objects.
‘And now that the right side of my body is much more flexible, at last I can enjoy going clubbing with friends.’
The UCL trial is recruiting patients with spasticity of the wrist or fingers for this study.
For more information, contact Luci Crook at [email protected] or call 0203 448 8758.
More information at stroke.org.uk or call the helpline on 0303 3033 100.