The use of botulinum toxin in paediatric hypertonia.

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.