Abstract
CP is the most common cause of chronic disability in childhood occurring in 2–2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. Moreover, the combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children. We include techniques for administration, side effects, and possible resistance as well as specific use in the upper and lower limbs muscles.
Highlights
Cerebral palsy (CP) is a group of permanent, non-progressive disorders of movement and posture resulting in activity limitations and forced dysmorphisms
When used at recommended doses, it avoids systemic side effects. This elimination of spastic components is mandatory in CP treatment because it allows affected individuals to use the residual component of selective motor control more effectively and functionally (Rosenbaum et al, 2002; Majnemer and Mazer, 2004)
To maximize the clinical effectiveness of botulinum toxin (BTX)-A, the toxin must be injected inside the fascia compartment of the muscle in a dose suitable of neutralizing the neuromuscular junction activity and in an adequate volume such that diffusion to the junctions at the end-plate area occurs while unwanted spread is minimized
Summary
Vito Pavone 1, Gianluca Testa 1, Domenico A. Restivo 2, Luca Cannavò 1, Giuseppe Condorelli 1, Nicola M. CP is the most common cause of chronic disability in childhood occurring in 2–2.5/1000 births. It is a severe disorder and a significant number of patients present cognitive delay and difficulty in walking. The use of botulinum toxin (BTX) has become a popular treatment for CP especially for spastic and dystonic muscles while avoiding deformity and pain. The combination of physiotherapy, casting, orthotics and injection of BTX may delay or decrease the need for surgical intervention while reserving single-event, multi-level surgery for fixed musculotendinous contractures and bony deformities in older children. This report highlights the utility of BTX in the treatment of cerebral palsy in children.
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