Lower-limb botulinum toxin A treatment in ambulant children with cerebral palsy

Cerebral palsy (CP) is frequently characterized by hypertonia, impairing motor function and affecting the quality of life of children and young people with CP (CYPwCP). Botulinum Toxin A (BoNT-A) has emerged as a widely utilized treatment modality to manage lower limb hypertonia in ambulant CYPwCP. This paper explores the current evidence base and clinical practice surrounding the use of BoNT-A in this population. BoNT-A injections are indicated for the management of focal lower limb hypertonia, targeting specific muscles that contribute to functional limitations. Clinical assessment plays a pivotal role in determining the suitability of BoNT-A treatment, with emphasis placed on evaluating tone, functional impairments, and individualized treatment goals. Timing of treatment is crucial, with interventions typically initiated when dynamic tone significantly impacts motor function and mobility. Optimal treatment age remains a topic of debate, with studies indicating benefits across various age groups. Close monitoring and regular follow-up evaluations are essential components of BoNT-A treatment, ensuring timely adjustments to address changing needs. BoNT-A represents a valuable therapeutic option for managing lower limb hypertonia in ambulant CYPwCP. Clinical decision-making should be guided by comprehensive assessments, utilization of appropriate outcome measures, and consideration of individualized treatment goals. Further research is warranted to elucidate optimal treatment strategies, long-term efficacy, and potential adverse effects to optimize outcomes in this patient population.