Botulinum toxin injection as an adjunct when planning hand surgery in children with spastic hemiplegia

The usefulness of botulinum toxin A treatment when planning hand surgery in eight children with spastic hemiplegia was evaluated. The hand function of the children was assessed before and after treatment using a test battery consisting of quantitative and qualitative functional assessment. The resul ts of preoperative botulinum treatment supported surgical intervention in f our children and serial botulinum treatment in three children. In one child , the preoperative botulinum treatment provided no additional information. We conclude that preoperative botulinum A treatment in most children with s pastic hemiplegia, for whom hand surgery is being considered, identifies th e patients who would not benefit from the planned surgery or for whom the f unctional benefit would probably not outweigh the burden of surgical proced ure and postoperative rehabilitation.