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Botulinum Toxin for Treatment of Spasticity in Cerebral Palsy

  • Kat KolaskiEmail author
  • L. Andrew Koman
Chapter

Abstract

Cerebral palsy (CP) is the most common cause of childhood disability. The causes of CP are multifactorial but the resultant non-progressive brain lesions most often occur prenatally. Clinical presentations are heterogeneous; common features include hypertonia, movement disorders, and negative signs. These have a reciprocal interaction with growth and development causing evolving symptoms over time. Spasticity is the most common motor disorder affecting 80–90% of children with CP. Over the past decade, botulinum toxin (BoNT) has become the standard of care for treating focal spasticity in children with CP. BoNT-A is used most widely, but most use in children is off-label in the US. Safe dosing requires consideration of the child’s functional level and co-morbidities. Administration can be done with manual needle placement, but the use of ultrasound and electrical stimulation has been shown to improve efficacy. Based on results of small, short-term clinical trials, evidence for improvement of limb spasticity in children with CP has been established, but the evidence for improving function is less certain. There is a lack of evidence for long-term improvements in spasticity, function, and other potential benefits. Concern for effects on muscle growth has been raised and warrants further investigation.

Keywords

Cerebral palsy Brain malformations White matter lesions Co-morbidities Functional classification Muscle growth Hypertonia Spasticity Evidence 

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryWake Forest School of Medicine, Medical Center BoulevardWinston-SalemUSA

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