Sonography-guided injection of botulinum toxin A in children with cerebral palsy

Visual identification of muscles and depth control of needle placement are the key features of sonography-guided injection that lead to improved targeting and safety of BoNT/A injections. This method may be especially helpful to validate already established injection techniques or when learning the correct injection technique. We recommend sonography-guided injection as a simple and painless "add-on" to the currently used standard procedure of palpation. The additional expenditure for sonography-guided injection is more than offset by the improved reliability in correct needle placement.