The Use of Botulinum Toxin in the Management of Cerebral Palsy in Pediatric Patients
The intramuscular use of botulinum toxin (Botox) for the purpose of neuromuscular blockade is accepted therapy for certain ocular and facial muscular imbalances, and its mechanism of action has been well described.1–15 The therapeutic use of Botox in larger skeletal muscle groups is not as well established. Direct intramuscular injections of Botox into the stemocleidomastoid, trapezius, and splenii muscles have resulted in clinical improvement in spasmodic torticollis;16,17 preliminary studies using Botox to treat focal foot and hand dystonias, upper limb spasticity in stroke patients, and spastic adductor muscles in patients with multiple sclerosis have been reported.4,5,18 Until recently, however, there have been no reports of Botox being used to manage the spasticity of cerebral palsy. Before discussing the use of Botox in this population, it is important to present a general overview of the pathophysiology of cerebral palsy and to point out the large number of patients with this disorder.
KeywordsCerebral Palsy Botulinum Toxin Botulinum Toxin Injection Hemifacial Spasm Focal Dystonia
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- 8.Kraft SP, Lang AE. Cranial dystonia, blepharospasm and hemifacial spasm: Clinical features and treatment, including the use of botulinum toxin. Can Med Assoc J 1988; 139: 837.Google Scholar
- 18.Tsui JKC, Snow B, Bhatt M, Varelas M, Hashimoto S, Caine DB. New applications of botulinum toxin in the lower limbs (Abstract). Neurology 1990; 40 (Suppl 1): 382.Google Scholar
- 19.Bleck EE. Orthopaedic Management in Cerebral Palsy. Philadelphia: J.B. Lippincott (1987).Google Scholar
- 20.Cerebral Palsy—Facts and Figures (Fact Sheet). United Cerebral Palsy Association, Inc., New York, August 9 (1986).Google Scholar
- 25.Silver RL, de la Garza J, Rang M. The myth of muscle balance: A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg 1985; 67-B:432.Google Scholar