[The risk-benefit of high doses of botulinum toxin injections for muscle spasticity ].
OBJECTIVE
To bring general elements of reflection on the use of the high doses of botulinum toxin in spastic children and adults.


METHODS
Review of the literature on the high doses and the benefit-risk associated with botulinum toxin injections.


RESULTS
The medical literature exclusively relates to the use of the high doses in children and adolescents. Comparative work with conventional doses suggests a relative interest, but with a risk of increased side effects. Several articles report on treatments with high and even very high doses in series of patient, with a documented effectiveness. But their justification remains partial and the study of the possible side effects is limited. Reflections are brought to contribute to the debate on the use of high doses, taking into account the local physiological effect of botulinum toxin, the risk of regional and general diffusion, the need for a progressive strategy, the variability of effects, the cost of the treatment and the need for obtaining an informed consent of the patient and of significant others.


CONCLUSIONS
The use of high doses of botulinum toxin increases progressively, but must remain very careful.
Rousseaux
M
M
Service de rééducation neurologique, Hôpital Swynghedauw, CHU, 59037 Lille cedex, France. mrousseaux@chru-lille.fr
Daveluy
W
W
D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007273:Injections, Intramuscular; D009128:Muscle Spasticity / Q000188:drug therapy*
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins