Clinical impact of antibody formation to botulinum toxin A in children

Herrmann, Jochen; Geth, K.; Mall, Volker; Bigalke, Hans; Mönting, Jürgen Schulte; Linder, Michaela; Kirschner, Janbernd; Berweck, Steffen; Korinthenberg, Rudolf; Heinen, Florian; Fietzek, Urban M.

doi:10.1002/ana.20098

Cited by 63 publications

(46 citation statements)

References 15 publications

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“…Recently, a modified constraint-induced therapy [21,22] has yielded promising results as a therapy with hemiplegic adolescents and adults with CP and combination of these two modalities remains to be assessed. Further, repeated injections beginning at the age of 3 may be expensive or may lead to non-responsiveness due to the formation of antibodies [23], thus emphasizing the need to combine the BTXA treatment with other methods (i.e. splints, orthoses, casts).…”

Section: Discussionmentioning

confidence: 99%

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

Sätilä

Kotamäki

Koivikko

et al. 2006

Pediatric Rehabilitation

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The objective of this study was to investigate the effects of botulinum toxin A (BTXA) treatment on impairment and function of the upper limb during a 2-year follow-up period. A prospective longitudinal study design with assessments before and after intervention was utilized, involving six patients with cerebral palsy (three boys and three girls) aged 3 years 4 months to 11 years 11 months at commencement of study. The outcome measures were spasticity (modified Ashworth, MAS), active and passive range of movement (ROM), grips (pinch, key grip, 3-finger grip, narrow cylinder grip, wide cylinder grip, pen grip and diagonal grip; grasping, releasing; pronation-supination), bimanual functions, fine motor functions (Melbourne Assessment of Unilateral Upper Limb Function), movement pattern (Upper Limb Physician's Rating Scale, ULPRS), functional skills and self-care capability (Paediatric Evaluation of Disability Inventory, PEDI), upper extremity use (House Classification) and cosmetic appearance. The assessments were repeated by the same examiners at baseline and at 1, 3 and 6 months after each BTXA treatment and then every 6 months until 24 months. One subject received a total of four injections (at 0, 6, 12 and 18 months), one two injections (at 0 and 12 months) and four one injection at the beginning of the study period. Upper extremity surgery was performed on two subjects during the study and one was operated on 2 months after completion of the study. All children benefited from the BTXA treatment in terms of reduction in muscle tone and increase in active and passive ROM. By 6 months, spasticity returned, but in four children passive and especially active ROM remained better than at baseline. No significant changes in grips, bimanual tasks or Melbourne Assessment scores were detected. The change in movement pattern (ULPRS) was maintained for 3 months in two children and beyond this in four, thus extending beyond the pharmacologic effects of botulinum toxin A. All but one child showed improvement in PEDI functional skill and caregiver assistance scale scores during the 2-year period. The House classification showed a one-grade improvement in one child at 1 month and in one child at 3 months and a three-grade improvement in one child at 3 months after BTXA treatment. After each treatment, the parents reported at least a one-grade improvement in cosmetic appearance in all children at 1 month and in four children maintained at least until 6 months. In two subjects operated during the study period, a distinct improvement in active and passive ROM and a two-grade improvement in the House classification were observed after the operation. In this limited series, the reduction in muscle tone after BTXA treatment did not translate into better gripping or quality of fine motor functions (Melbourne Assessment) of the affected hand, but seemed to have a positive effect on upper limb movement pattern (ULPRS), upper extremity use (House Classification) and cosmetic appearance. Assessment of upper limb function in a child with ...

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Section: Discussionmentioning

confidence: 99%

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

Sätilä

Kotamäki

Koivikko

et al. 2006

Pediatric Rehabilitation

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“…However, the lack of tachyphylaxis in our study and in the other published repeated dose studies [22,23] suggests that NAB formation is not a serious problem. Risk factors for the formation of NAB are a high BTX-A dose and short injection intervals [25]. For the detrusor, relatively long injection intervals are important in reducing the risk of NAB formation.…”

Section: Discussionmentioning

confidence: 99%

Injections of Botulinum Toxin A into the detrusor to treat neurogenic detrusor overactivity secondary to spinal cord injury

Liu

2010

Int Urol Nephrol

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“…In children undergoing BoNT treatment in the 90s up to 30% were reported to develop antibodies. 35 Although higher dosages per session have recently been administered to children with CP, secondary non-response due to the presence of antibodies is no longer experienced as a clinically relevant problem due to the use of reformulated BoNT. 21,24 This is in line with reports that have demonstrated reduced antigenicity of the reformulated preparation in adults with cervical dystonia.…”

Section: Section 8 Botulinum Toxin Therapy Continuation or Discontinumentioning

confidence: 99%

European consensus table 2006 on botulinum toxin for children with cerebral palsy

Heinen

Molenaers²,

Fairhurst³

et al. 2006

European Journal of Paediatric Neurology

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A B S T R A C TAn interdisciplinary group of experienced botulinum toxin users and experts in the field of movement disorders was assembled, to develop a consensus on best practice for the treatment of cerebral palsy using a problem-orientated approach to integrate theories and methods. The authors tabulated the supporting evidence to produce a condensed but comprehensive information base, pooling data and experience from nine European countries, 13 institutions and more than 5500 patients. The consensus table summarises the current understanding regarding botulinum toxin treatment options in children with CP.

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Clinical impact of antibody formation to botulinum toxin A in children

Cited by 63 publications

References 15 publications

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

Injections of Botulinum Toxin A into the detrusor to treat neurogenic detrusor overactivity secondary to spinal cord injury

European consensus table 2006 on botulinum toxin for children with cerebral palsy

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