Botulinum Toxin in Cerebral Palsy

Cerebral palsy is a distressing condition affecting children. The commonest, but not the only cause is a period of inadequate oxygen around the time of birth. The risk of this condition is in no small part responsible for the high caesarean section rate in the western world, as obstetricians will immediately perform caesarean section rather than entertain the slightest risk of allowing labour to progress when lack of foetal oxygen is a possibility.

The clinical picture of affected children is complex but one of the features is excessive tone in certain muscles causing spasm, and eventually permanent contractures. The function of the limbs can be severely affected, and walking may be prevented.

Traditional treatments include physiotherapy, stretching and splinting, all of which can be painful and distressing. More drastic treatments such as chemical destruction of muscles and surgical division of areas of the spinal cord have also been performed, but these destroy any residual function.

Treatment of affected legs with botulinum toxin is now a well established therapy although its use is confined to specialist centres. The treatment allows the spastic muscles to relax with consequent facilitation of physiotherapy and other treatments with a minimum of discomfort. It is also hoped that long-term therapy will delay or prevent the onset of contractures.