Clinical utility of botulinum toxin in the treatment of cerebral palsy: comprehensive review.

The physical properties, mechanism of action, and clinical evidence supporting the use of botulinum toxin in the management of spasticity in cerebral palsy are discussed. Assessment methods, patient selection criteria, and methodology for preparation and administration of botulinum toxin are discussed in detail and a treatment algorithm based on the cumulative experience of the author is provided. Botulinum toxin type A is well tolerated, safe, and effective in the treatment of patients with spastic cerebral palsy. Appropriate patient selection is imperative. Treatment goals need to be well defined and tailored to the individual patient's needs. Growth and development is a continuous and evolving process, necessitating the constant reassessment of the patient and modification of future treatment goals. The ultimate success of management in cerebral palsy is dependent on the development of a comprehensive spasticity team with complementing skills who, together, can significantly improve the quality of life of these patients.