Information for Parents of Children with Cerebral Palsy

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Botulinum Toxin A [BTA]

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What is Botulinum Toxin A?

Botulinum Toxin A [BTA] is a muscle relaxant derived from the bacterium Clostridium Botulinum. This bacteria has associations with botulism, a rare form of food poisoning, but can, like many toxic substances when used in small, controlled doses, provide safe, effective relief from a number of conditions. Currently BTA, under the brand name Botox™, is perhaps more commonly associated with face-lifts.

What Botulinum Toxin A is not

BTA is not a cure for cerebral palsy, nor is it a suitable treatment for all forms of cerebral palsy. 

Origins of the treatment

This is not a new treatment. BTA has been used therapeutically for over 20 years, mainly with adults, to treat a variety of conditions characterised by muscle hyperactivity.

Treatment aims

BTA is licensed in the UK to treat pes equinus in children with cerebral palsy. Pes equinus, often referred to as tip-toe walking, is very common in children with cerebral palsy, and results from spasticity in surrounding muscles which makes it difficult, or impossible, to place the foot flat on the floor. When injected into the calf muscle[s] [gastrocnemius and/or tibialis], BTA can relax these muscles, making walking easier and more comfortable, as well as generally improving balance and reducing the frequency of falls.

Tightness in the muscles at the back of the thigh [hamstrings], makes it difficult to straighten the leg/s, resulting in crouch or squat gait.  Injection with BTA can help straighten the legs, resulting in improvements in walking, sitting and/or transferring. BTA is also used to good effect on the adductor muscles in the hip, again a common problem area for children with spastic cerebral palsy. Too much muscle tone in this area impacts on the individual's mobility by making it difficult to keep the legs apart [also known as scissoring].  For those with upper limb spasticity, BTA can reduce muscle tone around the elbow, wrist and thumb areas and improve pinching, grasping and releasing movements.

In addition to these functional gains, BTA also has the potential to minimise the development of secondary problems. Spasticity can create an imbalance in muscle tone across a joint that not only interferes with motor function but can also lead to fixed contractures [permanent shortening of the muscle and tendon], bony abnormalities and joint instability, such as hip dislocation. 

Often surgery will be required, and the earlier this is carried out, the more likely it will need to be repeated as the child grows and matures. Lowering the tone of the more active muscle[s] by using BTA can restore balance across the joint, increase the stretch of the muscle and promote longitudinal growth, thereby possibly avoiding, or at least minimising, both potential damage to that joint and the need for surgical intervention. 

As the use of BTA has become more widespread in the treatment of cerebral palsy in both children and adults, goals have expanded to include pain relief, improved positioning, tremor and spasm control, drooling management and facilitation of personal care. Treatment prior to adductor release surgery can significantly reduce post-operative pain, pain management requirements and the length of stay in hospital. Many surgeons use BTA during operations to reduce painful post-operative spasms and to protect soft tissue from involuntary movement until the healing process is complete.

Many teenagers and adults with cerebral palsy report a high level of satisfaction with the cosmetic improvement that BTA can bring about to their appearance, even where there has been no significant change in function or movement.

Tiredness can often be a problem for people with cerebral palsy, due to the increased effort required in moving around. As movement becomes more fluid following BTA treatment, there is often a consequent reduction in energy consumption.


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