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Clinical Procedures Botulinum toxin injections for cerebral palsy and post-stroke spasticity: an overview

Introduction Botulinum Toxin Type-A (BTX-A) has received much attention by both medical and non-medical individuals. Clinical preparations of BTX-A such as Botox® (Allergan Inc, Irvine, CA) are available for cosmetic use by family physicians providing additional education is obtained. When injected intramuscularly, this toxin prevents the release of acetylcholine from presynaptic vesicles in the neuromuscular junction, thus temporarily and reversibly blocking muscle fibres. This ultimately leads to weakened muscular contractions. Although commonly associated with cosmetics, BTX-A is becoming an accepted pharmacologic treatment for other conditions, as injections for focal spasticity secondary to upper motor neuron disorders such as cerebral palsy or stroke have been utilized in medicine for some time and have been covered by OHIP since 2003. Nonetheless, the evidenced based support for such treatments does not always extend as far as randomized controlled trials (RCTs). It is the purpose of this article to explore the techniques for administering BTX-A to treat spastic muscular conditions, specifically cerebral palsy or post-stroke, while also exploring the clinical evidence associated with their use.