Botulinum toxin A in the management of children with cerebral palsy: indications and outcome

There is now considerable evidence to support the use of botulinum toxin A in the treatment of children with cerebral palsy. However, the clinical variability of cerebral palsy demands careful assessment and planning of treatment to obtain optimal results. Our approach to clinical assessment and management includes the use of three-dimensional gait analysis to answer specific clinical issues and evaluate the functional outcome. Botulinum toxin A should be used as part of an integrated programme in the management of children with cerebral palsy which also includes physiotherapy, orthoses and orthopaedic surgery. A management algorithm for the use of this toxin as therapy in children with cerebral palsy has been developed, based on our clinical experience and the results of a number of clinical trials.