Original article A French observational study of botulinum toxin use in the management of children with cerebral palsy: BOTULOSCOPE Emmanuelle Chale ´at-Valayer a,o, *, Bernard Parratte b,o , Cyrille Colin c , Ange ´lique Denis c , Se ´verine Oudin d , C. Be ´rard e , J.C. Bernard a , V. Bourg f , B. Deleplanque g , I. Dulieu h , P. Evrard i , P. Filipetti j , V. Flurin g , P. Gallien k , B. He ´ron-Long l , I. Hodgkinson e , I. Husson i , I. Jaisson-Hot c , E. Maupas f , F. Meurin m , G. Monnier b , D. Pe ´rennou h , B. Pialoux k , V. Quentin m , M. Simonetta Moreau f , M. Schneider a , Alain Yelnik n , Philippe Marque f a Croix-rouge franc ¸aise - Centre Me ´dico Chirurgical de Re ´adaptation des Massues, Lyon, France b CHU de Besanc ¸on, France c Po ˆle Information Me ´dicale Evaluation Recherche, Hospices Civils de Lyon, France d Mapi SAS, Lyon, France e Ho ˆpital Femme-Me `re-Enfant, Hospices Civils de Lyon, France f CHU de Toulouse, France g CHU de Bordeaux, France h CHU de Dijon, France i CHU Robert Debre ´, Paris, France j Centre Hospitalier Spe ´cialise ´ de l’Arche, Le Mans, France k CHU de Rennes, France l CHU Saint Vincent de Paul, Paris, France m Ho ˆpital National de Saint Maurice, Saint Maurice, France n CHU Lariboisie `re-Franc ¸ois Widal, Paris, France article info Article history: Received 17 July 2009 Received in revised form 12 April 2010 Accepted 25 April 2010 Keywords: Botulinum toxin Cerebral Palsy routine practice abstract Background: Dystonia and spasticity are common symptoms in children with Cerebral Palsy (CP), whose management is a challenge to overcome in order to enable the harmonized development of motor function during growth. Aim: To describe botulinum toxin A (BTX-A) use and efficacy as a treatment of focal spasticity in CP children in France. Methods: This prospective observational study included 282 CP children mostly administered according to French standards with BTX-A in lower limbs. Realistic therapeutic objectives were set with parents and children together before treatment initiation and assessed using the Visual Analogue Scale (VAS). Child management was recorded and the efficacy of injections was assessed during a 12-month follow-up period by physicians (Modified Ashworth Scale, joint range of motion, Physician Rating Scale, Gillette Functional Assessment Questionnaire and Gross Motor Function Measure-66) and by patients/parents (Visual Analogue Scale). Results: BTX-A treatment was administered in different muscle localizations at once and at doses higher than those recommended by the French Health Authorities. Children were * Corresponding author. Te ´ l.: þ33 4 72 38 48 23; fax: þ33 4 72 38 48 26. E-mail address: chaleat-valayer.e@cmcr-massues.com (E. Chale ´ at-Valayer). o E. Chaleat-Valayer and B. Parratte contributed equally to this work. Official Journal of the European Paediatric Neurology Society european journal of paediatric neurology 15 (2011) 439 e448 1090-3798/$ e see front matter ª 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ejpn.2010.04.006