[Botulinum toxin type A in children: evaluation of indications with a review of the literature]

Abstract

Introduction: The aim of this study is to review the literature to indications of botulinum toxin type A in children.

Method: We review the international literature from 1990 to 2002 by querying the Pubmed database with the keywords "children" and "botulinum toxin".

Results: Two hundred and forty-eight articles are retrieved. We selected the most relevant 64 articles among them. Several questions remain pending: which optimal dose, which periodicity for injections, which optimal age to prolong efficiency? The main criteria to estimate efficiency is functional ability improvement. No significant side effects are noted. The main use of botulinum toxin is the management of the spastic lower limb in cerebral palsy.

Discussion: This review of the literature makes it possible to specify the interests and the operational limits of botulinum toxin in the child. Its effectiveness with the upper limb is not proven. The other indications remain to be studied in a more precise way.

Conclusion: This review shows many studies give the indications of botulinum toxin in children. The main indication is the lower limb spaticity in cerebral palsy. New prospective and double-blind studies should be performed with larger samples.