title: Botulinum toxin treatment of children with cerebral palsy - a short review of different injection techniques.
abstract: The intramuscular application of botulinum toxin type A (BoNT/A) has emerged to be an established treatment option to reduce muscular hyperactivity due to spasticity in children with cerebral palsy. Accurate injection is a prerequisite for efficient and safe treatment with BoNT/A. So far, treatment procedures have not been standardized. This paper is a short review of different injection techniques, i.e., manual needle placement as well as guidance by electromyography, electrical stimulation, and ultrasound. Advantages and disadvantages of the different injection techniques are discussed with a focus on needle positioning within the targeted muscle, injection close to the neuromuscular junction and diffusion of BoNT/A within the target muscles and through fascia. The additional information gained by each injection technique is weighed in terms of the clinical impact for children with cerebral palsy.
authors.affiliation: Dr. von Hauner's Children's Hospital, Department of Paediatric Neurology and Developmental Medicine, University of Munich, Germany.
authors.forename: A S
authors.initials: AS
authors.lastname: Schroeder
authors.forename: S
authors.initials: S
authors.lastname: Berweck
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.forename: F
authors.initials: F
authors.lastname: Heinen
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002648:Child; D004058:Diffusion; D004558:Electric Stimulation; D004576:Electromyography; D006801:Humans; D007273:Injections, Intramuscular; D009469:Neuromuscular Junction / Q000187:drug effects; D010173:Palpation; D014463:Ultrasonography
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins