Recommendations for the use of botulinum toxin type A in the management ofcerebral palsy

Botulinum toxin type A (BTX-A) is increasingly bring used for the treatment of childhood spasticity, particularly cerebral palsy. However, until very recently, all such use in this indication has been unapproved with no gener ally accepted treatment protocols, resulting in considerable uncertainty an d variation in its use as a therapeutic agent. In view of the increasing aw areness of, and interest in, this approach to the treatment of spasticity, and also the recent licensing in a number of countries of a BTX-A preparati on fnr treating equinus deformity in children, it would seem timely to esta blish a framework of guidelines for the safe and efficacious use of BTX-A f or treating spasticity in children. This paper represents an attempt, by a group of 15 experienced clinicians and scientists from a variety of discipl ines, to arrive at a consensus and produce detailed recommendations as to a ppropriate patient selection and assessment, dosage, injection technique an d outcome measurement. The importance of adjunctive physiotherapy, orthoses and casting is also stressed. (C) 2000 Elsevier Science B.V. All rights re served.