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

Gait Posture. 2000 Feb;11(1):67-79. doi: 10.1016/s0966-6362(99)00054-5.


Botulinum toxin type A (BTX-A) is increasingly being 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 generally accepted treatment protocols, resulting in considerable uncertainty and variation in its use as a therapeutic agent. In view of the increasing awareness 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 preparation for treating equinus deformity in children, it would seem timely to establish a framework of guidelines for the safe and efficacious use of BTX-A for treating spasticity in children. This paper represents an attempt, by a group of 15 experienced clinicians and scientists from a variety of disciplines, to arrive at a consensus and produce detailed recommendations as to appropriate patient selection and assessment, dosage, injection technique and outcome measurement. The importance of adjunctive physiotherapy, orthoses and casting is also stressed.

Publication types

  • Review

MeSH terms

  • Animals
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / adverse effects
  • Botulinum Toxins, Type A / therapeutic use*
  • Cerebral Palsy / drug therapy*
  • Cerebral Palsy / physiopathology
  • Disease Models, Animal
  • Humans
  • Muscle Spasticity / drug therapy
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / adverse effects
  • Neuromuscular Agents / therapeutic use*
  • Patient Selection
  • Range of Motion, Articular
  • Treatment Outcome


  • Neuromuscular Agents
  • Botulinum Toxins, Type A