Botulinum toxin A in the management of upper limb spasticity in cerebral palsy.

Clinical experience thus far has shown BoNT-A to be a safe and efficacious method in the short to medium term management of spasticity of the upper limb in cerebral palsy. The relaxation of hypertonic musculature allows for improvement in function and posture, reduction of pain, and in some patients, improvement in cosmesis. It is also a valuable tool in predicting response to and guiding contemplated muscle-tendon surgery. Careful patient selection, detailed clinical assessment of deformity and disability, and a clear outline of treatment goals are essential to good outcomes. Further work needs to be done to determine optimum doses of BoNT-A for individual muscles and to evaluate the long-term outcome of repeated injections.