High dose of botulinum toxin type-A (BTX/A): safety and efficacy in patients with cerebral palsy

Abstract

Cerebral palsy (CP) is a severely debilitating condition. The underlying insult results in irreversible damage to the central nervous system, treatment is essentially palliative. Botulinum toxin type-A (BTX/A) Botox® Allergan, Inc. injections have been found to be effective palliation for dynamic spasticity in CP. There is a paucity of data regarding the maximum dose tolerated in the pediatric population. The present study examines the safety and efficacy of BTX/A therapy at up to 40 U/kg. Twenty-two patients were treated from 1995 to 1999. The population included four adults and 18 pediatric patients. Patients were in three groups: diplegia (n=12), hemiplegia (n=5), and quadriplegia (n=5). They were evaluated by the Modified Ashworth Scale. The incidence and severity of complications is also reported. The significance of these data is also commented upon. This study suggests that BTX/A therapy is safe, efficacious, and cost effective at higher doses, and should be considered as part of a comprehensive therapeutic regimen in appropriate candidates.

Outcome of delayed versus immediate casting on spasticity of lower limb muscles in cerebral palsy post-botulinum toxin injection

“…For reconstitution of botulinum toxin, in our study, we have opted for a lower volume of saline (4 mL for 200 U) for drug delivery. 19 Our intention is to reduce of systemic adverse effects. An increased frequency of systemic adverse events with large volume group has been reported by Lee et al 20 We did not encounter any adverse events following botulinum toxin injections with a low volume of saline as a reconstituent, which was comparable to Lee et al 20 We employed PSA using ketamine for the administration of botulinum toxin in target muscle groups.…”