Botulinum toxin treatment of children with cerebral palsy — a short review of different injection techniques
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The intramuscular application of botulinum toxin type A (BoNT/A) has emerged to be an established treatment option to reduce muscular hyperactivity due to spasticity in children with cerebral palsy. Accurate injection is a prerequisite for efficient and safe treatment with BoNT/A. So far, treatment procedures have not been standardized. This paper is a short review of different injection techniques, i.e., manual needle placement as well as guidance by electromyography, electrical stimulation, and ultrasound. Advantages and disadvantages of the different injection techniques are discussed with a focus on needle positioning within the targeted muscle, injection close to the neuromuscular junction and diffusion of BoNT/A within the target muscles and through fascia. The additional information gained by each injection technique is weighed in terms of the clinical impact for children with cerebral palsy.
KeywordsBotulinum toxin Cerebral palsy Ultrasound Electrical stimulation EMG Neuromuscular junction Diffusion Dilution
botulinum toxin type A
Gross motor function classification system
motor evoked potential
unit (mouse units of botulinum toxin type A)
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- Gracies J-M, D-J Weiszet al. (2002) Impact of botulinum toxin A (BTX-A) dilution and endplate targeting technique in upper limb spasticity.Ann. Neurol. Suppl.1, S87.Google Scholar
- Graham HK, KR Aoki, I Autti-Ramo, RN Boyd, MR Delgado, DJ Gaebler-Spira, ME Gormley, BM Guyer, F Heinen, AF Holton, D Matthews, G Molenaers, F Motta, PJ Garcia Ruiz and J Wissel (2000) Recommendations for the use of botulinum toxin type A in the management of cerebral palsy.Gait Posture 11(1), 67–79.PubMedCrossRefGoogle Scholar
- Koman LA, JF Mooney 3rd, BP Smith, F Walker and JM Leon (2000) Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. BOTOX Study Group.J. Pediatr. Orthop. 20(1), 108–115.PubMedGoogle Scholar
- Wissel J and W Poewe (2003) EMG for identification of dystonic, tremulous and spastic muscles and techniques for guidance of injections, In:Handbook of Botulinum Toxin Treatment, 2nd Edition (Moore NM, Ed.) (Blackwell Science:Oxford), pp 76–98.Google Scholar