Cerebral palsy (CP) is part of a spectrum of motor disorders that are associated with different levels of disability and pain. Cerebral palsy disorders are caused by nonprogressive injuries to the central nervous system in children under 3-years, resulting in neurological and musculoskeletal abnormalities. Symptoms include spasticity, athetosis, dystonia, rigidity, ataxia, motor control and balance difficulties, and muscle weakness that may worsen over time. Management of CP should address all of these clinical manifestations and encompass a multidisciplinary treatment approach to relieve symptoms and achieve as much functional restoration as possible.

Traditional pharmacologic treatment for CP includes oral agents and chemodenervating agents such as phenol, alcohol, and the botulinum toxins (BoNTs).  Although botulinum toxins are not indicated for use in CP in the United States, botulinum toxin type A has been widely used to treat focal spasticity and dystonia in patients with cerebral palsy.

Botulinum toxin can potentially be used as a primary therapy for focal spasticity. Reduction of spasticity can facilitate retraining of the affected limb enabling the child to adapt and develop skills to improve function and independence. Botulinum toxin may also be used as adjunctive therapy for regional or generalized spasticity. Appropriate use of BoNT therapy may be associated with benefits such as prevention of contractures thereby avoiding more invasive therapies, as well as enhancing treatment outcomes as part of combination therapy regimens.

This symposium will focus on the use of chemodenervation with botulinum neurotoxin in the management of motor disorders associated with cerebral palsy. Using pretreatment and posttreatment patient case histories, the symposium will feature a detailed interactive discussion of the assessment and treatment of clinical problems associated with cerebral palsy, including determination of an efficacious and cost-effective treatment plan for optimal patient outcomes.

1. Review the pathophysiology of the musculoskeletal deformities and motor disorders associated with cerebral palsy.
    
2. Describe treatment options for children with CP.
    
3. Discuss the efficacy of botulinum neurotoxins in the treatment of CP.
    
4. Review where treatment with botulinum neurotoxins fits into the management of patients with CP.
    
5. Discuss patient management and post injection care.