OP33 – 2365: Treatment with botulinum toxin of children with cerebral palsy has no added therapeutical value or cost-effectiveness for gross motor function, everyday physical activity levels or quality of life when combined with intensive functional physiotherapy

Catsman‐Berrevoets, Coriene E.; Bussmann, Johannes B. J.; Pangalila, Robert; Becher, Jules G.; Polinder, Suzanne; Steyerberg, Ewout; Stam, Henk J.; Schasfoort, Fabiënne C

doi:10.1016/s1090-3798(15)30034-9

Cited by 3 publications

(6 citation statements)

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“… 18 This is a disappointing outcome, and given the increasing information from animal studies demonstrating harmful effects of repeated intra-muscular BoNT-A injections, this poses serious questions as to the usefulness of this therapy. 25 It is incumbent on those who practise injection of BoNT-A to support the practice in individual children by objective measures of outcome, taking into consideration the expected spontaneous improvements in gait function and gross motor function in early childhood.…”

Section: Discussionmentioning

confidence: 99%

Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: A prospective kinematic study

Hastings-Ison

Sangeux

Thomason

et al. 2018

Journal of Children's Orthopaedics

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PurposeBotulinum toxin-A (or Botox) is widely used for the management of equinus gait in children with cerebral palsy but few recent studies have included instrumented gait analysis.MethodsThis was a prospective cohort study. Gait analysis was performed four weeks before and four weeks after Botulinum toxin-A injection for spastic equinus to detect the maximum effects on gait kinematics. Outcome measures included the Gait Profile Score (GPS), the Gait Variable Score (GVS) for the ankle, maximal ankle dorsiflexion and maximal knee extension at midstance.ResultsIn all, 37 children participated (20 boys); mean age five years seven months (4 years 1 month to 8 years 2 months); 19 with unilateral and 18 bilateral involvement. At a mean four weeks post-injection, the GPS and ankle GVS were unchanged. However maximum ankle dorsiflexion increased for the whole group; median 7.7° (confidence interval (CI) 4° to 10.6°) to 11.5° (CI 7.7° to 12.9°), p = 0.02. Maximum midstance knee extension was unchanged for the whole group, but median knee flexion increased in children with bilateral involvement; 10.9° (CI 7.4° to 20.8°) to 16.5° (CI 8.4° to 19.7°), p = 0.58.ConclusionInjections of the gastrocsoleus for spastic equinus did not result in objective improvements in overall gait. Improvements in ankle dorsiflexion for children with bilateral involvement may be offset by deterioration at the knee.Level of EvidenceII - prospective cohort study, before and after intervention

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Section: Discussionmentioning

confidence: 99%

Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: A prospective kinematic study

Hastings-Ison

Sangeux

Thomason

et al. 2018

Journal of Children's Orthopaedics

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“…Further, a more recent RCT (2015) showed no statistically significant evidence for the added value of BoNT‐A treatment followed by intensive physiotherapy compared with intensive physiotherapy alone . The trial found trends towards the intervention effect in favour of only intensive physiotherapy for improving gross motor function ( p =0.095), decreasing sedentary behaviour during everyday physical activity ( p =0.087), and improving quality of life ( p =0.066).…”

Section: Resultsmentioning

confidence: 97%

“…The 15 included articles reported economic evaluation results of ICER for the following interventions: prevention of CP ( n =4, including one conference abstract); botulinum toxin A (BoNT‐A) injection ( n =4, including one conference abstract); intrathecal baclofen (ITB) therapy ( n =3); functional electrical stimulation ( n =1); proximal femoral hardware retention ( n =1); web‐based home program ( n =1); and lifestyle intervention ( n =1) . Seven of these economic evaluations were conducted by a modelling approach, whereas six were economic evaluations alongside clinical studies or randomized controlled trials (RCTs).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies have assessed the cost‐effectiveness of BoNT‐A injection in the management of spasticity, but they demonstrate inconsistent results . In a modelled evaluation in the Australian setting, conducted as part of an application to the Pharmaceutical Benefits Advisory Committee for drug listing, the case is based on equivalent efficacy of BoNT‐A injection and serial casting.…”

Section: Resultsmentioning

confidence: 99%

“…Modelling simulation studies suggest that ITB could be cost‐effective or cost‐saving, although its efficacy is still to be verified by stronger evidence . However, inconsistent results of the cost‐effectiveness for BoNT‐A injection have been reported from four economic evaluation studies, mainly owing to the additional effectiveness of the treatment compared with the chosen comparator, for example serial casting, intensive physiotherapy, or standard treatment . Furthermore, some results are indicative and do not constitute strong evidence of value‐for‐money without evaluating long‐term effect or reporting ICER by QALYs.…”

Section: Discussionmentioning

confidence: 99%

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Economic evaluation and cost of interventions for cerebral palsy: a systematic review

Shih

Tonmukayakul

Imms

et al. 2018

Develop Med Child Neuro

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Prevention of CP would avoid significant economic burden. Some treatments and interventions have been shown to be cost-effective, although stronger evidence of clinical effectiveness is needed. What this paper adds Cost-effectiveness evidence shows prevention is the most significant strategy. Some treatments are cost-effective, but stronger evidence for long-term effectiveness is required. Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications.

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Transcutaneous high-frequency alternating current for rapid reversible muscle force reduction below pain threshold

2019

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Objective. The development of non-invasive, quickly reversible techniques for controlling undesired muscle force production (e.g. spasticity) could expand rehabilitation approaches in those with pathology by increasing the type and intensity of exercises that can be performed. High-frequency alternating current (HFAC) has been previously established as a viable method for blocking neural conduction in peripheral nerves. However, clinical application of HFAC for nerve conduction block is limited due to the invasiveness of surgical procedures and the painful onset response. This study aimed to examine the use of transcutaneous HFAC (tHFAC) at various stimulation frequencies to address these shortfalls. Approach. Ten individuals participated in the study. Surface electrodes were utilized to apply tHFAC (0.5–12 kHz) to the median and ulnar nerves. Individual pain threshold was determined by gradual increase of stimulation amplitude. Subjects then performed a force-matching task by producing grip forces up to the maximal voluntary contraction level with and without application of tHFAC below the pain threshold. Main results. Pain threshold current amplitude increased linearly with stimulation frequency. Statistical analysis showed that both stimulation frequency and charge injected per phase had significant effects (p < 0.05) on grip force reduction. At the group level, application of tHFAC below pain threshold reduced grip force by a maximum of 40.7% ± 8.1%. Baseline grip force trials interspersed between tHFAC trials showed consistent grip force, indicating that fatigue was not a factor in force reduction. Significance. Our results demonstrate the effectiveness of tHFAC at reducing muscle force when applied below the pain threshold, suggesting its potential clinical viability. Future studies are necessary to further elucidate the mechanism of force reduction before clinical application.

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OP33 – 2365: Treatment with botulinum toxin of children with cerebral palsy has no added therapeutical value or cost-effectiveness for gross motor function, everyday physical activity levels or quality of life when combined with intensive functional physiotherapy

Cited by 3 publications

References 0 publications

Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: A prospective kinematic study

Onabotulinum toxin-A (Botox) for spastic equinus in cerebral palsy: A prospective kinematic study

Economic evaluation and cost of interventions for cerebral palsy: a systematic review

Transcutaneous high-frequency alternating current for rapid reversible muscle force reduction below pain threshold

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