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The benefit of botulinum toxin (BoNT) in reducing upper extremity spasticity is undisputed.

The syndrome of the first motoneuron consists of three main components: spasticity, paresis and reduced control. Spasticity often leads to an inclination of the thumb, flexion of the fingers, flexion and mostly ulnar deviation of the wrist, flexion in the elbow as well as adduction and internal rotation of the shoulder. Hand and arm are no longer in the child’s field of activity; motor impairment is accompanied by invisibility—this increases the learned non-use of the hand. Many children also experience the bending of the elbow or the abduction in the shoulder when walking as very unpleasant. Both processes reinforce the asymmetric body experience. With this typical finding and the resulting disability, there is a medical indication for treatment with BoNT.

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Becher, T. (2021). Botulinum Toxin. In: Bahm, J. (eds) Movement Disorders of the Upper Extremities in Children. Springer, Cham.

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