Botulinum Toxin in Children with Cerebral Palsy: An Update

Abstract

Injected in a muscle, the botulinum toxin causes localized and temporary paralysis by acting on the neuromuscular synapse. Currently, it is widely prescribed for the treatment of limb spasticity in children from the age of 2 years. Combined with rehabilitation and other treatments, it helps to progress in motor learning, promotes functional progression, and delays orthopaedic degradations. Numerous randomized, placebo-controlled studies have shown efficacy in reducing spasticity, improving passive and active mobility, reducing pain, and improving upper limb comfort care. The side effects are rare and commonplace. The injection technique is accessible after specific training and practice. The indication is better evaluated by a multidisciplinary team. A precise clinical evaluation, assisted by an instrumental analysis (videography, spatiotemporal parameters, kinematics, kinetics, and electromyography), makes it possible to determine the aims of the treatment and to evaluate the outcome. The objective of this review is to present current evidence base and practices regarding the use of botulinum toxin in children with cerebral palsy.