[The risk-benefit of high doses of botulinum toxin injections for muscle spasticity ]. / Place des doses élevées dans les injections de toxine botulique.

ABSTRACT

OBJECTIVE: To bring general elements of reflection on the use of the high doses of botulinum toxin in spastic children and adults. MATERIAL AND METHODS: Review of the literature on the high doses and the benefit-risk associated with botulinum toxin injections. RESULTS: The medical literature exclusively relates to the use of the high doses in children and adolescents. Comparative work with conventional doses suggests a relative interest, but with a risk of increased side effects. Several articles report on treatments with high and even very high doses in series of patient, with a documented effectiveness. But their justification remains partial and the study of the possible side effects is limited. Reflections are brought to contribute to the debate on the use of high doses, taking into account the local physiological effect of botulinum toxin, the risk of regional and general diffusion, the need for a progressive strategy, the variability of effects, the cost of the treatment and the need for obtaining an informed consent of the patient and of significant others. CONCLUSION: The use of high doses of botulinum toxin increases progressively, but must remain very careful.