[High doses of botulinum toxin type A in children: efficacy and safety in clinical practice].

The purpose of this article is to examine the current state of administering high doses botulinum toxin type A for the treatment of childhood spasticity, particularly Cerebral Palsy. The inter-relationship between the Cerebral Palsy neurological maturation and the early management is discussed, including identification of common gait patterns and the choice of target muscles for focal or multi focal spasticity management. High doses of botulinum toxin type A, when multilevel and integrated management approach is indicated, appear to be a safe, efficacious treatment for multi focal Cerebral Palsy spasticity. A review of literature guides the clinician about necessary adaptation of botulinum toxin doses and found no evidence that higher doses result in a increase of complications. Further studies would be interesting in order to evaluate long term safety and efficacy of this therapy in Cerebral Palsy.