Date of Award


Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)


Physician Assistant Studies

First Advisor

Julie Solberg


Botulinum toxin; Cerebral palsy; Spasticity; Lower limb spasticity


Cerebral palsy affects 3 out of every 1000 children in the United States. It is multifactorial and not fully understood. What is known is that most of the cerebral palsy cases are congenital and the majority of motor dysfunction is classified as spastic. Over the last 25 years botulinum toxin has been a part of the first line treatment in children with spasticity. The purpose of this literature review is to determine if botulinum toxin is as safe and effective compared to a placebo or therapy alone in children. Key words and mesh terms were used in AccessMedicine, Cochrane Review, Pubmed, CINAHL complete, and Ebsco databases to find studies within the last five years that focused on pediatric participants with cerebral palsy and lower limb spasticity. Narrowing the search down brought 12 articles that were not sponsored by drug companies, realized their own limitations, and were focused on pediatric patients with lower extremity spasticity. Areas that were focused on include gait and motor function, safety of botulinum toxin, duration of injection, and combination therapy. The data shows botulinum toxin when used as part of a comprehensive rehabilitation program is most beneficial by delayed surgeries, reduced pain, and improved range of motion which improved gait in children under the age of seven. However, the dose, injection site, and repetition of injections should be individualized to each patient to minimize adverse events and be the most effective.