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Position paper on the use of botulinum toxin in cerebral palsy
  1. L J Carra,
  2. A P Cosgroveb,
  3. P Gringrasc,
  4. B G R Neville on behalf of the UK Botulinum Toxin and Cerebral Palsy Working Partya
  1. aDepartment of Neurosciences, The Wolfson Centre, Mecklenburgh Square, London WC1N 2AB, UK, bDepartment of Orthopaedics, Musgrave Park Hospital, Stockman’s Lane, Belfast BT9 7JB, UK, cHarper House, Radlett, Hertfordshire WD7 7HU, UK
  1. Dr Carr.

https://doi.org/10.1136/adc.79.3.271

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    There is growing interest in the therapeutic role of botulinum toxin A (BTA) in cerebral palsy.1 The drug is currently unlicensed for this use, but a number of small trials have indicated that BTA may be used safely and effectively in the management of spasticity and dystonia in cerebral palsy.2-7 In 1995, a working party was established to examine the status of BTA treatment in this new context. This has resulted in the following position paper. The paper aims to summarise current evidence regarding indications, efficacy, and the known side effects of treatment.

    Clostridium botulinum is an anaerobic bacterium that produces seven immunologically distinct strains of neurotoxin (A–G). This potent and potentially lethal toxin blocks the synaptic release of acetylcholine from cholinergic nerve terminals. The toxin exerts its main effect at the neuromuscular junction, resulting in irreversible loss of motor endplates. The muscle is paralysed until nerve sprouting establishes new junctions.8 BTA has been developed commercially, and in the UK is currently licensed for use in the treatment of blepharospasm, hemifacial spasm, and spasmodic torticollis. However, BTA is more widely used clinically: in adults, particularly in the management of focal dystonias and acquired spasticity.9 Since first reports in 1993,2 3BTA has also been increasingly used in children with cerebral palsy.

    The UK Botulinum Toxin and Cerebral Palsy Working Party was established in 1995. This multidisciplinary group meets annually to discuss developments in the clinical use of BTA and recent scientific advances. At every meeting scientific publications are reviewed and research questions are explored. The following position paper is fully referenced but does not include a comprehensive literature review (this can be found in a recent annotation by Forssberg and Tedroff10).

    The initial meeting of the UK Botulinum Toxin and Cerebral Palsy Working …

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    Footnotes

    • The working party represents the following disciplines: paediatrics, paediatric and adult neurology, orthopaedics, adult rehabilitation, pharmacology, physiotherapy, and orthotics.

    • The participants were: Mr R Baker, Dr A Bakheit, Dr B Bhakta, Dr L Carr, Mr AP Cosgrove, Mr C Drake, Mr N Eames, Dr P Gringras, Dr J Heckmatt, Ms L Katatchburian, Mr GJ Maclean, Dr R McWilliam, Dr G McArthy, Dr AP Moore, Dr R Morton, Dr C Murray-Leslie, Professor B Neville (Chaiman), Mrs F Polack, Ms K Richardson, Dr S Roussounnis, Mr D Scrutton, Dr V Shrubb, Dr M Smith, Ms E Wills, Professor A Wallace, and Professor C Ward.

    • The group plans to liaise with professional bodies and users of BTA by establishing a register of recognised groups using BTA in the research and management of cerebral palsy. The group further aims to promote and coordinate research, particularly collaborative studies. It is therefore compiling registers of research in progress, which are held at the Neurosciences Unit, Institute of Child Health, The Wolfson Centre, Mecklenburgh Square, London WC1N 2AP, UK with details of research projects and their coordinators.