Effectiveness and Safety of Botulinum Toxin Type A in Children with Musculoskeletal Conditions: What Is the Current State of Evidence?

Abstract

Children with musculoskeletal conditions experience muscle weakness, difficulty walking and limitations in physical activities. Standard treatment includes physiotherapy, casting, and surgery. The use of botulinum toxins appears as a promising treatment on its own, but usually as an adjunct to other treatment modalities and as an alternative to surgery. The objectives were to establish the evidence on the effectiveness, safety and functional outcome of BTX-A in children with musculoskeletal conditions. A literature search using five electronic databases identified 24 studies that met our inclusion criteria. Two randomized clinical trials were included; most studies were case studies with small sample sizes and no control group. Improvements in gait pattern, function, range of motion, reduction of co-contractions, and avoidance of surgical procedures were found following BTX-A injections. Adverse events were not reported in 10 studies, minor adverse events were reported in 13 children and there were no severe adverse events. Additional doses appear safe. BTX-A is a promising treatment adjunct in improving functional outcomes in children with musculoskeletal conditions. Future studies including larger samples, longer follow-up periods and a comparison group are required to provide evidence on the effectiveness and safety of this drug in children with musculoskeletal conditions.

Differences between motor point and innervation zone locations in the biceps brachii. An exploratory consideration for the treatment of spasticity with botulinum toxin

“…For maximum effectiveness, BTX should be injected into the NMJ, for which a guidance to define this site should be used. There is no consensus about the technique used to define the BTX injection site (Dahan-Oliel et al, 2012). In deep muscles, ultrasound (Picelli et al, 2012), invasive electrical stimulation (ES) Lee et al, 2012 and needle electromyography (EMG) Childers, 2003 are used. Except for the latter, these techniques do not locate NMJ exactly.…”

Anatomical versus functional motor points of selected upper body muscles

“…The effectiveness of therapeutic injections like BTX appears to be directly affected by accurate needle positioning, but no consensus exists with regard to these locations . In previous studies, it was controversial as to whether therapeutic injections should be performed in an area with a high density of NMJs (reflected by the MP identified by NMES) or in the anatomic NEP .…”

Effectiveness and safety of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with brachial plexus birth injury (POPB-TOX), a randomised controlled trial: study protocol

“…Systemic effects are rare and include generalised allergic reactions and effects related to product diffusion (rash, erythema, pruritus, anaphylactic reaction, flu-like syndrome, headaches, dizziness, fever, shivering, hypertension, and abdominal pain and dry mouth). Exceptionally, serious effects have been observed, a type of excessive muscle weakness, dysphagia and aspiration pneumonia; however, these occurred principally when the recommended doses were not respected 25 31–33. The safety of BTI in infants under 2 years of age was shown to be good in a recent systematic review25 and the tolerance of this treatment also seems good in this population 22 33 34.…”

“…Exceptionally, serious effects have been observed, a type of excessive muscle weakness, dysphagia and aspiration pneumonia; however, these occurred principally when the recommended doses were not respected 25 31–33. The safety of BTI in infants under 2 years of age was shown to be good in a recent systematic review25 and the tolerance of this treatment also seems good in this population 22 33 34. The specific effects on muscle structure and the contractile properties of muscles are, however, poorly understood.…”