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Spasticity / Botulinum Toxin (Botox)

The use of Botulinum Toxin A (Botox) In the management of Children with Cerebral Palsy

One of the goals of the orthopaedic management of children with cerebral palsy is to postpone any needed surgery until the patient is nearly finished growing. Attempts are also made to complete all necessary procedures during one single event of anesthesia.

The injection of Botulism Toxin A (Botox) is a non-surgical procedure with which to manage tight or over-active muscles and maintain range of motion. Botox injections allow noticeable improvements in positioning and function and may help children delay the need for surgery. If a tight muscle becomes more relaxed, other muscles may work to become stronger.


Botox is a protein produced by the bacterium Clostridium botulinum. The effects of botulinum have been know for many years, but only since 1980 has the toxin been found to be useful for a number of neurologic disorders.

For selected children with cerebral palsy, injections of Botox are made into portions of the muscles which are too tight or too active. The toxin is a nerve "blocker." It binds to the nerve endings and prevents the release of chemicals that activate muscles. These chemicals carry the "message" from the brain that causes a muscle to contract. If the message is blocked, the muscle is weakened.


A physical therapist may evaluate your child prior to the injection. Photographs or video may be made of your child' legs, feet, arm and /or hands.

Depending on the muscle or muscles that is being targeted, the procedure may be carried out in the clinic or under sedation/anesthetic. Some physicians use an electrical nerve stimulator to help target the specific site for the injection.

The effects of botox are not permanent. The onset of action may not be immediate, but may take 24-48 hours to appear. Once spasticity has diminished, physical therapy and bracing can be initiated. Most patients experience improvement for an average of three to six months. However, the nerve endings usually grow new connections to the muscles and treatment may be repeated as directed by your physician. Botox is an effective treatment for the relief of symptoms only - it is not a cure. And, because every patient is different, the degree of relief will vary from person to person.

Side Effects

Botox appears to be safe in all patients and has little side effects. The most common complaints are:

  1. Soreness or stiffness of the injected muscles. Soreness is often experienced with any injection and may last for two to three days. A dose of Tylenol before the injection and followed every 4-6 hours as needed after the injection may help relieve the soreness.
  2. Redness or slight swelling at the injection site. This should also subside in 24-48 hours. If you have any questions or problems following the injections, please do not hesitate to call us:

Pediatric Orthopaedics
Children's Hospital
1600 7th Avenue South
Birmingham, Al 35233-1711