Effects of botulinum toxin A on upper limb spasticity in children with cerebral palsy

Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):53-9; quiz 75-6. doi: 10.1097/00002060-200001000-00012.


Objective: Botulinum toxin A inhibits presynaptic release of acetylcholine at the neuromuscular junction and has reportedly been successful in the treatment of spastic disorders. This prospective study attempted to determine whether botulinum toxin A injection resulted in clinically measurable gains for 4 mo.

Design: Measurements were obtained from 32 children (range, 1-18 yr; average age, 6.9 yr) with hemiplegic or quadriplegic cerebral palsy before and at 1, 3, and 4 mo after botulinum toxin A injections. Spasticity was measured using the Modified Ashworth Scale for 12 different joints.

Results: Results showed that spasticity as measured by Ashworth scores for elbow and wrist extension clearly declined (P < 0.02) by 1 mo after botulinum toxin A injection, and diminished spasticity continued for 3-4 mo. Caregivers reported improvement in subjectively rated management, appearance, and function. However, patient response to botulinum toxin A injection was not predictable. Age had no significant relationship to gains.

Conclusions: Further research is needed on the use of botulinum toxin A to diminish spasticity and improve function.

MeSH terms

  • Adolescent
  • Anti-Dyskinesia Agents / therapeutic use*
  • Botulinum Toxins, Type A / therapeutic use*
  • Cerebral Palsy / drug therapy*
  • Cerebral Palsy / physiopathology
  • Child
  • Child, Preschool
  • Elbow Joint / physiopathology
  • Hemiplegia
  • Humans
  • Infant
  • Muscle Spasticity / drug therapy
  • Muscle Spasticity / physiopathology
  • Prospective Studies
  • Quadriplegia
  • Range of Motion, Articular
  • Wrist Joint / physiopathology


  • Anti-Dyskinesia Agents
  • Botulinum Toxins, Type A