THE USE OF BOTULINUM TOXIN TREATMENT IN CHILDREN WITH MOVEMENT-DISORDERS

Botulinum toxin A can be used to correct movement disorders in childre n and may alter the course of the disorder. We treated 38 children wit h this toxin, administering one to four treatments with a minimum of 3 months between treatments. The maximum total dose per treatment episo de was 6 U/kg or 200 U (BOTOX(R); Allergan Inc., Irvine, California, U SA) divided between a maximum of six muscles. Physiotherapy after each injection was used to maximize the benefit of the toxin. Of 19 childr en treated to improve their function, 13 showed a clear response. In 1 4 children in whom botulinum toxin A was administered during a presurg ery evaluation to mimic the effect of tendon lengthening, the results supported the decision to proceed to surgery in eight. Of five patient s with increasing spasticity, three experienced a reduction in muscle tension. We conclude that repeated injections of botulinum toxin A can lead to a permanent improvement in movement disorder. Furthermore, th e need for surgery can be estimated by using this toxin, and the decis ion to proceed with the surgery or to postpone it may be made on the b asis of the toxin's effects.