Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?

Graham, H. Kerr; Boyd, Roslyn N.; Carlin, John B.; Dobson, Fiona; Lowe, Kevin; Nattrass, Gary; Thomason, Pam; Wolfe, Rory; Reddihough, Dinah

doi:10.2106/jbjs.f.01416

Cited by 160 publications

(163 citation statements)

References 24 publications

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“…Consistent with other RCTs of BoNT-A, 17 further follow-up of the sample posttrial identified some children who died. Significant morbidity and mortality are associated with nonambulatory CP and comorbid epilepsy 18 ; however, overall life expectancy, particularly for children with severe disabilities, has improved over a 20-year period.…”

Section: Discussionsupporting

confidence: 83%

Safety of Botulinum Toxin Type A for Children With Nonambulatory Cerebral Palsy

et al. 2015

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To determine safety of intramuscular botulinum toxin A (BoNT-A) injections to reduce spasticity and improve care and comfort of nonambulatory children with cerebral palsy (CP).METHODS: Nonambulatory children with CP were randomly allocated to receive either BoNT-A (n = 23) or sham procedure (n = 18) in Cycle 1. In Cycle 2, the BoNT-A group received a second episode of BoNT-A (n = 20) and sham group received their first episode of BoNT-A (n = 17). A pediatric rehabilitation specialist masked to group allocation graded each adverse event (AE) according to system, severity (mild, moderate, serious, sentinel) and causality (unlikely/ unrelated; possible; probable/definite).RESULTS: There was no difference for all moderate/serious AEs between the BoNT-A and sham/ control groups in either Cycle 1 (incident rate ratio = 1.30, 95% confidence interval = 0.43-4.00; P = .64) or Cycle 2 (incident rate ratio = 0.72, 95% confidence interval = 0.30-1.75; P = .47). In Cycle 2, 1 serious, 3 moderate (single-episode group), and 24 mild (single-episode group n = 10; 2 episode group n = 14) AEs were probably/definitely related to BoNT-A.

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Section: Discussionsupporting

confidence: 83%

Safety of Botulinum Toxin Type A for Children With Nonambulatory Cerebral Palsy

et al. 2015

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“…They also concluded that deformity is not necessarily linked to spasticity and that reduction of spasticity may not prevent deformity. This is similar to the conclusion reached by Graham et al 1 in their recent randomized controlled study on hip dysplasia. Tedroff et al found that the rate of progression of deformity did not appear to be influenced by age, GMFCS level, or pattern of CP.…”

supporting

confidence: 92%

“…Tedroff et al found that the rate of progression of deformity did not appear to be influenced by age, GMFCS level, or pattern of CP. This is interesting as progression of deformity in children with CP has been shown to be influenced by the severity of involvement of the child; 1 given the heterogenous nature of the study group a wide variation in outcome would have been expected. Variation in the number of courses of BoNT-A was noted, however: 14 of 94 children had a single injection only, due to an adverse reaction or a lack of response, and 28 more children left during the study period, 13 of whom required orthopaedic surgery for progressive deformity.…”

mentioning

confidence: 99%

Does botulinum toxin prevent or promote deformity in children with cerebral palsy?

Gough

2009

Develop Med Child Neuro

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“…All the patients were available for follow-up (Table 1). The mean age at the time of surgery was 10.3 years (range: [4][5][6][7][8][9][10][11][12][13][14][15], and the mean follow-up period was 16 mo (range: 9-28). The demographics, orthopedic manifestations, and age at surgery are shown in Table 1.…”

Section: Methodsmentioning

confidence: 99%

“…The risk of progressive hip subluxation and/or dislocation is higher in patients with GMFCS Ⅳ and Ⅴ ratings [5] . In 50%-70% of CP patients, hip displacement can make perineal care difficult [2,3,[9][10][11][12][13] , alter sitting balance [13][14][15] , and be a source of pain [2,3,[14][15][16][17][18] . Most clinicians agree that surgical treatment is indicated for progressive hip subluxation in this patient population [3,4,[18][19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications

Canavese¹

2013

WJO

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AIM:To describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. METHODS:Twenty-one non-ambulatory children and adolescents (22 hips) were consecutively treated with percutaneous pelvic osteotomy, which was used in conjunction with varus, derotational, shortening femoral osteotomy and soft tissue release, to correct progressive hip subluxation and acetabular dysplasia. The age, gender, Gross Motor Function Classification System level, side(s) of operated hip, total time of follow-up, immediate post-operative immobilization, complications, and the need for revision surgery were recorded for all patients. RESULTS:Seventeen patients (81%) were classified as GMFCS level Ⅳ, and 4 (19%) patients were classified as GMFCS level Ⅴ. At the time of surgery, the mean age was 10.3 years (range: 4-15 years). The mean Reimers' migration percentage improved from 63% (range: 3%-100%) pre-operatively to 6.5% (range: 0%-70%) at the final follow-up (P < 0.05). The mean acetabular angle (AA) improved from 34.1° (range: 19°-50°) pre-operatively to 14.1° (range: 5°-27°) (P < 0.05). Surgical correction of MP and AA was comparable in hips with open (n = 14) or closed (n = 8) triradiate cartilage (P < 0.05). All operated hips were pain-free at the time of the final follow-up visit, although one patient had pain for 6 mo after surgery. We did not observe any cases of bone graft dislodgement or avascular necrosis of the femoral head. CONCLUSION:Pelvic osteotomy through a less invasive surgical approach appears to be a valid alternative with similar outcomes to those of standard techniques. This method allows for less muscle stripping and blood loss and a shorter operating time.

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Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?

Cited by 160 publications

References 24 publications

Safety of Botulinum Toxin Type A for Children With Nonambulatory Cerebral Palsy

Safety of Botulinum Toxin Type A for Children With Nonambulatory Cerebral Palsy

Does botulinum toxin prevent or promote deformity in children with cerebral palsy?

Percutaneous pelvic osteotomy in cerebral palsy patients: Surgical technique and indications

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