Botulinum-Toxin-Induced Muscle Fasciculations in Children with Cerebral Palsy: A Case-Series Study

Cerebral palsy (CP) is a group of permanent, but not immutable, disorders of movement and posture caused by a non-progressive lesion or an abnormality in the development of the immature brain. It is the leading cause of motor disability in childhood. The most common sign is muscle spasticity, which leads to the development of contractures and bone deformities. Among the treatments for spasticity, botulinum toxin injection has the strongest scientific evidence and is used from the age of 2 years. In this article, we report three pediatric patients with CP who developed muscle fasciculations after botulinum toxin injection, which were administered according to planned dosages and required clinical monitoring and stretching by a healthcare professional. We review the literature and analyze the possible physiopathological mechanisms; however no other similar clinical cases have been reported. In conclusion, we propose to include muscle fasciculations as a potential transient and non-harmful adverse effect of botulinum toxin infiltration, which remains the treatment of choice for muscle spasticity when combined with rehabilitation in cerebral palsy.