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  • Print publication year: 2009
  • Online publication date: July 2009

14 - The use of botulinum toxin in spastic infantile cerebral palsy



Cerebral palsy is not a specific disease but a group of clinical syndromes, caused by a non-progressive injury to the developing brain that results in a disorder of movement and posture that is permanent but not unchanging. It is the most common cause of physical disability affecting children in developed countries. The incidence is steady in most countries at approximately 2/1000 live births. The location, timing, and severity of the brain lesion are extremely variable, which results in many different clinical presentations. Despite the static nature of the brain injury, the majority of children with cerebral palsy develop progressive musculoskeletal problems such as spastic posturing and muscle contractures (Koman et al., 2004).


Cerebral palsy may be classified according to the cause of the brain lesion (when this is known), and the location of the brain lesion as noted on imaging such as magnetic resonance imaging or computerized tomography scan. Clinically more useful classification schemes are based on the type of movement disorder, the distribution of the movement disorder (Box 14.1), and the gross motor function of the child.

It is important to correctly characterize the movement disorder because different movement disorders can be managed by different interventions.

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Koman, L. A., Smith, B. P. & Shilt, J. S. (2004). Cerebral palsy. Lancet, 363(9421), 1619–31.
Palisano, R. J., Rosenbaum, P., Walter, S., et al. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol, 45, 113–20.
Russman, B. S., Tilton, A. H. & Gormley, M. E.. (2002). Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinum toxin in treatment. In Mayer, N. H. & Simpson, D. M., eds., Spasticity: Etiology, Evaluation, Management, and the Role of Botulinum Toxin. New York: WE MOVE, pp. 134–43.
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