[Botulinum toxin. Use in the treatment of spasticity in children]

The medical treatment of spasticity has improved since the introduction of botulinum toxin type A (BTA) for intramuscular injection into spastic muscles. Two not directly comparable preparations are on the market: Botox and Dysport. Botox is four times as potent as Dysport. BTA is especially used for spasticity in legs, arms, and the paravertebral musculature. Surface analgesic cream is applied and an oral or rectal sedative is given after which BTA is injected locally according to strict instructions. In the motor end plate, BTA blocks the release into the synaptic cleft of acetylcholine from vesicles in the terminal nerve fibres, thereby bringing about paralysis of muscle fibre. Blockade lasts for about four months. The treatment must therefore be repeated. Because the treatment is local, side effects are few, mild, and acceptable.