Evidence-based review of safety and efficacy in cerebral palsy.

The introduction of botulinum toxin has been a major advance in the care of children with cerebral palsy. Clinically the positive effects of treatment with botulinum toxin are seen in patients with all levels of GMFCS. Botulinum toxin has been established in multiple studies to reduce spasticity in the upper and lower extremities, although there is some conflicting evidence regarding function. The medication is felt to be generally safe with a low incidence of adverse events which are temporary and self-limited. However there is the recognition that severe weakness may rarely occur. Ultimately it is incumbent upon the physician to consider both risks and benefits in determining the best treatment plan for the individual patient.