Botulinum toxin and surgical intervention in children and adolescents with cerebral palsy: who, when and why do we treat?

Valentine, Jane; Davidson, Sue-Anne; Bear, Natasha; Blair, Eve; Ward, Roslyn; Thornton, Ashleigh; Stannage, Katherine; Watson, Linda; Forbes, David; Elliott, Catherine

doi:10.1080/09638288.2019.1644381

Cited by 12 publications

(9 citation statements)

References 46 publications

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“…Population-based health programs and CP-registers are a possible source of information to shed some light on these issues. There is some evidence to propose that, combined with other treatment modalities, the injections may have helped to maintain or improve function at a later age, postponed the age for surgery, reduced the incidence of re-operations, and lowered the prevalence of surgical procedures, e.g., Achilles tendon lengthening or multi-level interventions [129][130][131][132].…”

Section: Lessons Learned From the Repeated Treatment Studiesmentioning

confidence: 99%

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Sätilä

2020

Toxins

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Botulinum toxin type A (BTXA) has been used for over 25 years in the management of pediatric lower and upper limb hypertonia, with the first reports in 1993. The most common indication is the injection of the triceps surae muscle for the correction of spastic equinus gait in children with cerebral palsy. The upper limb injection goals include improvements in function, better positioning of the arm, and facilitating the ease of care. Neurotoxin type A is the most widely used serotype in the pediatric population. After being injected into muscle, the release of acetylcholine at cholinergic nerve endings is blocked, and a temporary denervation and atrophy ensues. Targeting the correct muscle close to the neuromuscular junctions is considered essential and localization techniques have developed over time. However, each technique has its own limitations. The role of BTXA is flexible, but limited by the temporary mode of action as a focal spasticity treatment and the restrictions on the total dose deliverable per visit. As a mode of treatment, repeated BTXA injections are needed. This literature reviewed BTXA injection techniques, doses and dilutions, the recovery of muscles and the impact of repeated injections, with a focus on the pediatric population. Suggestions for future studies are also discussed.

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Section: Lessons Learned From the Repeated Treatment Studiesmentioning

confidence: 99%

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Sätilä

2020

Toxins

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“…A population-based study of botulinum toxin treatment and lower limb surgery in 771 children born in 2000–2009 (aged 8–17 years) in Western Australia also reported a higher number of operations with higher GMFCS levels ( 11 ). The Kaplan–Meier survival curves in our study, even if they also included surgery on the upper extremity, spine, and pelvis, show that the proportions of children having had surgery for the different GMFCS levels appear largely to agree.…”

Section: Discussionmentioning

confidence: 99%

“… The table is designed to facilitate comparison with Valentine et al ( 11 ). GMFCS: Gross Motor Function Classification System; SS: surgical session.…”

Section: Participants and Methodsmentioning

confidence: 99%

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Orthopedic surgical procedures in 3,305 children and young adults with cerebral palsy: a register-based cohort study

Telléus

Kiapekos

Heideken

et al. 2022

ActaO

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Background and purpose: Few reports have described the panorama of orthopedic surgeries that children with cerebral palsy (CP) undergo. We analyzed the risk of a first surgery, and describe the frequency of orthopedic surgeries in terms of age, sex, anatomical location, and Gross Motor Function Classification System (GMFCS) level in children and young adults with CP.Patients and methods: This was a register-based cohort study of 3,305 individuals followed until 2–25 years of age. We used data from 2 national Swedish registers: the CPUP CP surveillance program and the Swedish National Patient Register. Kaplan–Meier survival curves were calculated to describe the risk of undergoing a first orthopedic surgery, related to age.Results: We included data for 3,311 orthopedic operations in 1,717 surgical sessions. The percentage of children operated on before age 15 years increased from 22% (95% CI 19–26) for GMFCS level I to 70% (CI 64–75) for level V. Ankle and foot surgery was predominant as first surgery for GMFCS I–II, and hip and femur surgery for GMFCS IV–V. Spinal surgery occurred almost exclusively for GMFCS IV–V. Descriptive data showed repeated surgical sessions to be frequent for higher GMFCS levels.Interpretation: The risk of having a first orthopedic surgical treatment increased with increasing GMFCS level and was initiated at younger age in children with higher GMFCS level.

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“…wide population of children and adolescents with CP in WA and provides accurate tracking of interventions [4].…”

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confidence: 99%

A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term Botulinum toxin type A use

et al. 2020

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Background: The aim of this study is to contribute to the knowledge base on the long-term outcomes of evidence-based medical interventions used to improve gross motor function in children and adolescents with Cerebral Palsy. Method: Prospective cohort study of children with Cerebral Palsy in the birth years 2000-2009 attending a tertiary level service for children with Cerebral Palsy who's first recorded Gross Motor Function Classification System level was II. Results: A total of 40 children were eligible for the study, of whom 28 (72.7%) enrolled. The Botulinum toxin A treatment for this cohort, (median and interquartile ranges) were: total number of lower limb Botulinum toxin A injections 11 (6.7, 5.5); total dose of Botulinum Toxin A per lower limb treatment 6.95 u/kg (4.5, 11); and dose of Botulinum Toxin u/kg/muscle 2.95 (2.2, 4). For all 28 subjects there was a median of 15 (8.5 to 22) Gross Motor Function Classification System level recordings: six of the 28 children (21.4%) improved from level II to level I, the remaining 22 children remained stable at level II (78.6%). In this highly treated population, the average 66 item Gross Motor Function Measure score for the 22 children in level II was 72.55, which is consistent with the mean of 68.5 reported in the original Ontario cohort. Conclusion: This cohort study has confirmed that children with Cerebral Palsy, Gross Motor Function level II treated at a young age with repeated doses of Botulinum Toxin A within an integrated comprehensive service, maintain or improve their functional motor level at a later age. Background Cerebral Palsy (CP), the most common motor disorder of childhood, was described by Rosenbaum et al. in 2007 as a 'group of permanent disorders of the development of movement and posture that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain' [1, 2]. The Australian Cerebral Palsy Register has recorded the prevalence of CP as 2.1 per 1000 live births [3]. Perth Children's Hospital (PCH), Western Australia (WA) (population 2.4 million) is the state centre for the management of motor disorders in children and adolescents with CP. In 2003 following new funding from the West Australian government an evidence-based clinical program for children with CP in WA was established and is known as the Cerebral Palsy Mobility Service (CPMS). As part of the funding a database, the Paediatric Rehabilitation Information System (PRIS), was established, with retrospective data entry for children with CP to 1995 [4]. In a recent retrospective audit, we confirmed that the CPMS manages the state

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Botulinum toxin and surgical intervention in children and adolescents with cerebral palsy: who, when and why do we treat?

Cited by 12 publications

References 46 publications

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Orthopedic surgical procedures in 3,305 children and young adults with cerebral palsy: a register-based cohort study

A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term Botulinum toxin type A use

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