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Neurotoxicity Research

, Volume 9, Issue 2–3, pp 189–196 | Cite as

Botulinum toxin treatment of children with cerebral palsy — a short review of different injection techniques

  • A. S. Schroeder
  • S. Berweck
  • S. H. Lee
  • F. Heinen
Article

Abstract

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.

Keywords

Botulinum toxin Cerebral palsy Ultrasound Electrical stimulation EMG Neuromuscular junction Diffusion Dilution 

Abbreviations

BoNT/A

botulinum toxin type A

CP

cerebral palsy

EMG

electromyography

GMFCS

Gross motor function classification system

MEP

motor evoked potential

NMJ

neuromuscular junctions

U

unit (mouse units of botulinum toxin type A)

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Copyright information

© Springer 2006

Authors and Affiliations

  • A. S. Schroeder
    • 1
  • S. Berweck
    • 1
  • S. H. Lee
    • 1
  • F. Heinen
    • 1
  1. 1.Dr. von Hauner’s Children’s Hospital, Department of Paediatric Neurology and Developmental MedicineUniversity of MunichMunichGermany

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