Botulinum toxin has become an important component of standard practice in the management of children with hypertonia (spasticity or
dystonia). Following
intramuscular injection, the
neurotoxin causes a reversible neuromuscular blockade, creating both
muscle weakness and a reduction in tone. Frequent goals of
botulinum toxin injection include improving motor function, promoting longitudinal muscle growth and decreasing painful
muscle spasms. The neuromuscular blockade lasts for three to six months on average. The clinical effect may last longer and the safety profile is excellent. Strong evidence, including randomized trials, exists for the efficacy of
botulinum toxin in the management of lower and upper extremity tone in children. Common clinical indications include
spastic equinus (toe walking), hip subluxation, upper extremity spasticity associated with
hemiplegia or
quadriplegia, and multilevel leg muscle
injections in children with
spastic diplegia.