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Best Clinical Practice in Botulinum Toxin Treatment for Children with Cerebral Palsy

Department of Paediatric- and Neuro-Orthopaedics, Orthopaedic Hospital Rummelsberg, 90592 Schwarzenbruck, Germany and MOTIO, 1080 Vienna, Austria
Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road Headington, Oxford OX3 7LD, Oxfordshire, UK
Department of Paediatric- and Neuro-Orthopaedics, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland
Centre de Réadaptation de COUBERT (Ugecam) 77170, France and ROMATEM, Etiler Istanbul 34337, Turkey
Department of Pediatric Orthopaedics, Timone Children’s Hospital and Institute of Motion Science, CNRS, UMR 7287, Aix-Marseille University, 264, Rue Saint Pierre, 13385 Marseille Cedex 05, France
Department of Paediatrics, Hospital Infantil La Paz, Universidad Autonóma de Madrid, Madrid, Spain
Orthopedic Department, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
Author to whom correspondence should be addressed.
Academic Editor: Bahman Jabbari
Toxins 2015, 7(5), 1629-1648;
Received: 9 March 2015 / Revised: 29 April 2015 / Accepted: 5 May 2015 / Published: 11 May 2015
(This article belongs to the Collection Botulinum Toxins on Human Pain)
Botulinum toxin A (BoNT-A) is considered a safe and effective therapy for children with cerebral palsy (CP), especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS) of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age. View Full-Text
Keywords: botulinum toxin; BoNT-A; Cerebral palsy; child development; spasticity; treatment recommendation botulinum toxin; BoNT-A; Cerebral palsy; child development; spasticity; treatment recommendation
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Strobl, W.; Theologis, T.; Brunner, R.; Kocer, S.; Viehweger, E.; Pascual-Pascual, I.; Placzek, R. Best Clinical Practice in Botulinum Toxin Treatment for Children with Cerebral Palsy. Toxins 2015, 7, 1629-1648.

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