Botulinum Toxin Type A in Children and Adolescents With Severe Cerebral Palsy

Abstract

This retrospective cohort study reviewed set goals and their outcomes of children and adolescents with severe cerebral palsy who received botulinum toxin A in 2008 and 2009. Sixty children (36 male, mean age 9 years) were included. They received on average 4 (range 1-7) treatments, with the dosage varying between 20 and 400 units per treatment (3-21 U/kg/body weight). Mild transient side effects were reported in 12 of 242 treatments with botulinum toxin A. Treatment goals were related to lower limb function (82%), range of motion (68%), positioning (33%), upper limb function (33%), and facilitating ease of care in dressing (30%), toileting, and diapering (22%). The treatment goals were reached in 60% to 85% by report of the parent and child dyad. Our findings suggest that botulinum toxin A should be considered as a treatment option in patients with cerebral palsy within Gross Motor Function Classification System levels IV and V.

Severity of cerebral palsy and likelihood of adverse events after botulinum toxin A injections

“…10,11,14 Further research is required to clarify the relationship between pre-existing comorbidities in children with CP and the incidence and severity of adverse events after BoNT-A injections. Our results suggest that while adverse events after BoNT-A are common, most are minor and self-limiting.…”

“…5 The Gross Motor Function Classification System (GMFCS) enables classification of children with CP based on their gross motor function ability. [11][12][13][14] Adverse events after BoNT-A administration have been reported with an incidence of 3% to 23% of injection episodes, with the majority being transient and mild. 4,[7][8][9][10] Additionally, the treatment has been shown to be effective in non-ambulant children (GMFCS levels IV and V) for decreasing pain; ease of positioning and dressing; and improving hygiene.…”

“…[11][12][13][14] Adverse events after BoNT-A administration have been reported with an incidence of 3% to 23% of injection episodes, with the majority being transient and mild. 14 Concern has been raised that injected BoNT-A may spread systemically and trigger adverse events distant from the site of injection, such as dysphagia, aspiration pneumonia, generalized weakness, and death. 16,17 Children with severe CP (GMFCS levels IV and V) may be at higher risk of adverse events, 18 with one study reporting adverse events in 5% of injection episodes in this group.…”

Treatment with botulinum toxin in children with cerebral palsy: a qualitative study of parents' experiences

“…Repeated BoNT-A injections could, however, mean several anaesthetic sessions per year for a child. In a retrospective study (Mesterman et al 2014) including children with GMFCS levels 4 and 5 more children were injected with relaxing medication and distracting techniques, and only 13% of the children had received general anaesthesia. In our study parents suggested that other health care visits were negatively affected by the experiences from the painful injection.…”

Systemic adverse events after botulinum neurotoxin A injections in children with cerebral palsy

“…Several studies have been published that support decisionmaking in this area. Total adverse events after BoNT-A have been reported to occur in 3.3% to 56% of injection episodes, [11][12][13][14][15] reflecting different study designs. Adverse events with symptoms suggesting systemic spread are less common, 16 estimated to occur in 1% to 2.2% of injection episodes.…”