Botulinum Toxin for Treatment of Spasticity in Cerebral Palsy

  • Kat KolaskiEmail author
  • L. Andrew Koman


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.


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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