Botulinum Toxin: Techniques Within Pediatric Physiatry

Paulson, Andrea; Zigler, Christina K.; Houtrow, Amy J.; Pruitt, David W.

doi:10.1016/j.pmrj.2018.06.004

Cited by 11 publications

(12 citation statements)

References 37 publications

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“…There is practice variability regarding how BoNT-A procedures are performed at different institutions. Sedation and pain management during BoNT-A procedures range from general anesthesia, sedation, oral medications, topical medications, or distraction alone [13]. These procedure-related factors also need to be considered when resuming BoNT-A procedures.…”

Section: Discussionmentioning

confidence: 99%

A risk-stratified approach toward safely resuming OnabotulinumtoxinA injections based on dosing and ambulatory status in pediatric patients with cerebral palsy during the Coronavirus pandemic of 2019 (COVID-19)

McLaughlin

Fisher

Vadivelu

et al. 2020

PRM

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PURPOSE: After the onset of the Coronavirus pandemic of 2019–2020 (COVID-19), physicians who inject OnabotulinumtoxinA (BoNT-A) were left with determining risks and benefits in pediatric patients with cerebral palsy. Many of these patients have pre-existing conditions that make them more prone to COVID-19 symptoms, and this susceptibility potentially increases after BoNT-A injections. METHODS: A retrospective chart review of 500 patients identified 256 pediatric patients with cerebral palsy who received an intramuscular BoNT-A injection to determine relative doses used for each Gross Motor Functional Classification Score (GMFCS). Data regarding age, weight, GMFCS, BoNT-A total body dosage, and inpatient hospitalizations for 6 months post-injection were collected. Differences between GMFCS levels were analyzed using one-way analysis of variance testing. Inpatient hospitalizations were recorded and assessed using relative risk to determine the population risk of hospitalization in the setting of initiating injections during the COVID-19 pandemic. RESULTS: Based on GMFCS level, patients who were GMFCS I or II received fewer units of BoNT-A medication per kilogram of body weight compared to GMFCS III–V (p< 0.0005, F= 25.38). There was no statistically significant difference in frequency or time to hospitalization when comparing patients receiving BoNT-A compared to a control group. CONCLUSIONS: Resumption of BoNT-A injections during the time of COVID-19 requires a systematic approach based on risks and potential benefits. Data from this analysis does not show increased risk for patients who received injections historically; however, recommendations for resumption of injections has not previously been proposed in the setting of a pandemic. In this manuscript, a tiered approach to considerations for injections was proposed. Botulinum toxin type A injections have a history of improving spasticity in the pediatric patient with cerebral palsy. Ensuring appropriate selection of patients for injection with BoNT-A during this pandemic is increasingly important.

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Section: Discussionmentioning

confidence: 99%

A risk-stratified approach toward safely resuming OnabotulinumtoxinA injections based on dosing and ambulatory status in pediatric patients with cerebral palsy during the Coronavirus pandemic of 2019 (COVID-19)

McLaughlin

Fisher

Vadivelu

et al. 2020

PRM

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“…Against the intervention Some clinicians would recommend the use of BoNT-A in children under the age of 2 while others would not. Currently, BoNT-A may be used ~ 20% of children wit CP ages 1-3 years (Franzen 2019), but there is a wide variation in practice patterns in general (Paulson 2019).…”

Section: Recommendation Direction X In Favor Of the Interventionmentioning

confidence: 99%

Assessments and Interventions for Spasticity in Infants With or at High Risk for Cerebral Palsy: A Systematic Review

Ayala

Winter

Byrne

et al. 2021

Pediatric Neurology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…These doses also differed to those in the Paulson et al . survey of mainly paediatric physiatrists where up to 30 Units/kg and 1200 Units maximum were reported 8 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

“…7 These doses also differed to those in the Paulson et al survey of mainly paediatric physiatrists where up to 30 Units/kg and 1200 Units maximum were reported. 8 The safety profile of BoNT-A use in children is now well established however, where adverse events do occur, they can be worrying in more disabled children who may also have significant co-morbidities. 9,10 The occurrence of systemic adverse events has been found to be low 11,12 but are of concern in the more disabled where they occur more frequently than in the those who have less involvement.…”

Section: What This Paper Addsmentioning

confidence: 99%

Current Australian clinical practice in use of botulinum toxin‐A to manage paediatric hypertonicity

O'Flaherty

Stewart

2021

J Paediatrics Child Health

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Aim To describe current rehabilitation paediatricians' use of intramuscular botulinum toxin‐A (BoNT‐A) to manage hypertonicity. Methods Cross‐sectional survey. Results In late 2019, 32 of the 35 identified Australian rehabilitation paediatricians who use BoNT‐A to manage paediatric hypertonicity completed the survey. Annually, they administer just over 3750 courses of BoNT‐A to manage hypertonicity with a mean of 11 years of clinical experience. Sedation was used by all but 1 clinician who used a number of other strategies during the procedure. Mean (and median) maximum dose of OnabotulinumtoxinA (Botox) was 400 Units (range 300–450 Units). Only three clinicians indicated that they used AbobotulinumtoxinA (Dysport) – the other BoNT‐A preparation approved for children available in Australia; analysis of its use was not performed. Dose modifications were made by clinicians according to a patient's response to a previous course of BoNT‐A (88% of respondents); patient experience of a previous adverse event (78%); history of aspiration or dysphagia (65 and 63%, respectively); and the presence of dystonia; and where the patient was GMFCS level V (53% each). Intervals between courses ranged from 3 to 24 months with the variation due to clinical circumstances. Conclusion Clinical practice in BoNT‐A management of paediatric hypertonicity was largely consistent in regard to maximum doses of OnabotulinumtoxinA (Botox) used. Dose modification and time between injection courses varied according to individual clinical presentation. Procedural sedation was used extensively.

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Botulinum Toxin: Techniques Within Pediatric Physiatry

Abstract: Level IV.

Cited by 11 publications

References 37 publications

A risk-stratified approach toward safely resuming OnabotulinumtoxinA injections based on dosing and ambulatory status in pediatric patients with cerebral palsy during the Coronavirus pandemic of 2019 (COVID-19)

A risk-stratified approach toward safely resuming OnabotulinumtoxinA injections based on dosing and ambulatory status in pediatric patients with cerebral palsy during the Coronavirus pandemic of 2019 (COVID-19)

Assessments and Interventions for Spasticity in Infants With or at High Risk for Cerebral Palsy: A Systematic Review

Current Australian clinical practice in use of botulinum toxin‐A to manage paediatric hypertonicity

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