Botulinum Toxin A in the management of upper limb spasticity in cerebral palsy

Botulinum Toxin A has been used in the management of focal dystonia for more than 20 years and in that of focal spasticity for more than 10 years. There have been many open label studies and randomized clinical trials demonstrating efficacy and safety in the management of lower limb spasticity in children with cerebral palsy, especially dynamic equinus (toe walking). In children with juvenile cerebral palsy (JCP), there are good grounds to suggest that Botulinum Toxin A may be more beneficial in the upper limb than in the lower limb and further clinical trials are warranted. Botulinum Toxin A has not been approved for management of upper limb spasticity in children in any country. All such use is "off label" and should be undertaken only in the context of clinical trials, Botulinum Toxin A therapy has several upper limb indications and should be considered complementary to such interventions as occupational therapy, splinting, casting, and muscle-tendon surgery.