The use of botulinum toxin in children: A retrospective study of adverse reactions and treatment of idiopathic toe-walking

The safety of botulinum toxin A therapy in children with cerebral palsy has been examined in a retrospective postal survey of patients treated with this toxin. Seventy-eight per cent of respondents reported no complications. Fever was the most common adverse event, but some patients also reported swelling, transient weakness and deterioration in walking. The only significant problem was prolonged weakness in one patient, whose walking was still severely impaired 2 years following the injections, indicating the injections were not the sole reason for the gait changes. Overall, this survey suggests that this toxin can be used safely in children at a dose of up to 10 U/kg. The efficacy of the toxin was examined in a study of eight children with idiopathic toe-walking. Each limb was injected with botulinum toxin A at 4-5 U/kg with the aim of achieving 10°of dorsiflexion. Toe-walking was resolved in all patients, indicating that the therapy is efficacious in this patient group.