1. Cerebral palsy in children Prevalence: 3-4 / 1000; Clinical forms: following evident motor involvement: spastic: diplegia;quadriparesia;Hemiplegia; triplegia; spastic: diplegia;quadriparesia;Hemiplegia; triplegia; ataxic; ataxic; dyskynetic: dystonic; athetoid; dyskynetic: dystonic; athetoid; Hypotonic; Hypotonic;

2. Prof Battisti O, Bot-Tox-a Muscles contraction: relevant anatomy Cortex primary motor area Basal ganglia Bulbar reticular structure cerebellum - Adjacent structures + Alpha / gamma motoneurons of anterior horn + + muscles Sensory receptors: Muscles, tendons, bones, peritoneum - Posterior horn + + 2

3. Prof Battisti O, Bot-Tox-a Muscles contractions: 1 nerve per motor unit, componed of 3-15 interlaced muscles fibers that cann’t be individualized ) D membrane Pot Release of Ac Cho Na+ influx SRE Ca++ efflux Troponin ( actin+myosin ) overlap= Muscles contraction nicotin Curare, Ach esterase ATP, glycogen, Pcri = energy 3

4. Prof Battisti O, Bot-Tox-a Clinical presentation Motor involvement: spasticity, ataxia, dyskinesia, hypotonia; Motor involvement: spasticity, ataxia, dyskinesia, hypotonia; Vision impairement and disorder of communication Vision impairement and disorder of communication Feeding disorder Feeding disorder Epilepsy Epilepsy Orthopedic disorder Orthopedic disorder Emotional and psychological disturbances Emotional and psychological disturbances 4

5. Prof Battisti O, Bot-Tox-a Therapeutics in CP Physiotherapy Physiotherapy « castings » « castings » Botulinum toxin Botulinum toxin Intrathecal baclofen Intrathecal baclofen Improve daily life function Improve daily life function Mental pattern Mental pattern Self-esteem Self-esteem Nutrition Nutrition Pain Pain convulsions convulsions Increase in force Increase in dexterity Better movements Better equilibrium Better self-concept More independency 5

6. Prof Battisti O, Bot-Tox-a Muscles concerned by the injections: example for one side… Iliopsoas: 2 sites; Iliopsoas: 2 sites; Hamstrings: 4 sites; Hamstrings: 4 sites; Adductors: 2 sites; Adductors: 2 sites; Gastrecnomius: 4 sites; Gastrecnomius: 4 sites; Tibialis anterior: 2 sites; Tibialis anterior: 2 sites; Other:… Other:… 6

7. Prof Battisti O, Bot-Tox-a Then normal program of physiotherapy But with another energy and motivation… More interaction between infant, family, physio, doctor, friends and school; 7

8. Prof Battisti O, Bot-Tox-a8

9. En « résumé »… 9