Botulinum Toxin A (BTA) can help children with cerebral palsy

In recent years, research has shown that it has benefits for some children with cp. The benefits are twofold:

• It reduces tightness of the muscles permitting more control of movement during the toxinís effects.
• It increases the stretch of the muscle to encourage longitudinal growth, thereby reducing the risk of permanent muscle contractions.

BTA works by blocking the signal that the nerves are trying to pass to the muscle. It is generally recognised that in the short term any side-effects are rarely serious and always temporary. As a leading neurologist recently stated "Properly controlled trials in the UK and abroad appear to show short-term benefit and safety in carefully selected children. Parents should understand that, as yet, there is no longer-term controlled evidence that toxin is better than traditional therapies. We believe it will be, but cannot yet be sure."

BTA is dissolved in saline and under either local or general anaesthetic is injected deep into the muscle. The time for the BTA to take effect on the calf and hamstring muscle tone of the people in the project in Belfast was between one and four days. It reached its maximum effect after two weeks and remained stable for 6-16 weeks. After this there was a gradual return to normal tone over the following two months. The injections are then repeated to maintain the improvement in tone.

Physiotherapy is also part of the treatment with BTA. The research in Belfast (1) showed that by using BTA injections there is the possibility of delaying or even avoiding surgery or other treatments that stretch and lengthen the muscles.

As at March 2000 there are two BTA products that have a licence for use on children with cerebral palsy - Botox© and Dysport©. However Scope would want to point out that BTA injections are not suitable for all children with cp and that patient selection is very important. A recent Position Paper on BTA injections stated that "patient selection should be done in a paediatric setting. A multidisciplinary team is required for patient selection, drug administration and subsequent management. Team members should have experience in the management of cerebral palsy and, as a minimum, should include a doctor and a physiotherapist, with an orthotist available. For effective management a certain level of expertise is required ñ for this we feel centres should be treating at least 10 children annually."