Botulinum toxin A.

Botulinum toxin (Botox) type A acts on the acetylcholine receptors at myoneural junction and helps in reducing spasticity. Action is seen within 3 weeks and lasts for about 6 months. This therapy can allow for improved range of motion, reduced deformity, improved response to occupational and physical therapy, and delay in the need for surgical management of spasticity. Casting, with or without botulinum toxin type A, may be an additional option for children with deformity. Use of orthotics and physiotherapy prolongs the need for repeat injections. Repeat injections are often required around 4-6 years of age and around 11-13 years during rapid growth spurts. The injection is given according to weight of patient and the muscle involved. Each small muscles requires around 1-2 U/Kg and large muscles 4-6 U/Kg.