Effects of low-dose botulinum toxin for the treatment of spastic children with cerebral palsy

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Published Dec 27, 2025
https://doi.org/10.62438/tunismed.v103i10.5636
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Vol. 103 No. 10 (2025): Tunis Med Oct 2025

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Soumaya Boudokhane
Department of Physical Medicine and Functional Rehabilitation, Fattouma Bourguiba University Hospital of Monastir, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
Iheb Belhadj Youssef
Physical Medicine Unit, Ksar Helal Regional Hospital, Monastir, Tunisia
Fatma Zaouali
Department of Family Medicine, University of Monastir, Monastir, Emergency Department/SMUR, Tahar Sfar University Hospital, Mahdia, Tunisia
Ons Borgi
Physical Medicine Unit, Ksar Helal Regional Hospital, Monastir, Tunisia
Amine Kalai
Department of Physical Medicine and Functional Rehabilitation, Fattouma Bourguiba University Hospital of Monastir, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
Houda Migaou
Department of Physical Medicine and Functional Rehabilitation, Fattouma Bourguiba University Hospital of Monastir, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
Zohra Ben Salah
Department of Physical Medicine and Functional Rehabilitation, Fattouma Bourguiba University Hospital of Monastir, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia

Abstract

Introduction: The treatment of children with cerebral palsy (CP) with Botulinum toxin A (BTA) injections is well established, safe and effective. However, a standardized injection strategy is still missing and the used dosage has escalated over the years. The aim was to analyze the efficacy and safety of a lower dose of BTA injections into lower limb in children with CP.


Material and Method: We analyzed retrospectively BTA injections for children with spastic CP aged between 2 and 14 years. Treatment results were evaluated with the modified Ashworth scale (MAS). Side effects, total dose and dose per body weight were analyzed.


Results: Fifty five children were included (21 girls (38.2%) and 34 boys (61.8%)). The total dosage was 105.4 ± 20.7 U Allergan for Botox® and 473.4 ± 79.9 U Speywood for Dysport®. Average MAS before treatment was 2.1±0,5. At the first post-injection follow up visit, this score had increased to 1±0.5. Symptoms potentially related to TBA were reported in 16 children (29.1%). In 39 cases, the injection of TBA passed without adverse events. Multiple side effects were observed with the same patient.


Conclusion: There is not yet a uniform strategy for TBA treatment in childre with CP and the doses used in the literature vary considerably over the years. It thus appears that the doses we use are within the range of the recommandations but remain by far lower than the doses used in the literature.

Keywords:

botulinum toxin type A , cerebral palsy , children, striated muscle , efficacy, tolerance

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