Cerebral palsy is not a specific disease, but a clinical syndrome caused by a non-progressive injury to the developing brain that results in a disorder of movement and posture that is permanent but not unchanging. Spasticity is the most common movement disorder, affecting between 60% and 80% of children with cerebral palsy, and can manifest as spastic hemiplegia, spastic diplegia and spastic quadriplegia. Dystonia is characterized by involuntary sustained or intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures or both. Athetosis, or intermittent writhing movement, is also very common. These movement disorders are all amenable to treatment with botulinum neurotoxin (BoNT). This chapter discusses topographical symptom distribution and illustrates the typical forms of cerebral palsy using an anatomical approach to management. Common clinical patterns of spastic posturing, the major involved, muscles and dose ranges for the different toxin preparations are tabulated.

Movement disorders are rarely medical emergencies or reason for evaluation in the emergency department (ED). However, they may be seen, and range from the familiar parkinsonism and drug-induced dystonia to rare disabling hemiballism secondary to a stroke. Movement disorders are typically a sign of an underlying neurological or nonneurological disorder, rather than the primary diagnosis. They can be strange in appearance and are often misdiagnosed as being hysterical or psychiatric in origin. In the ED, movement disorders are diagnosed based on a history and physical examination, with relatively few contributions from laboratory and radiographic studies.