Should botulinum toxin A injections be repeated in children with cerebral palsy? A systematic review

Abstract

ICFInternational Classification of Function, Disability and Health ICF-CY International Classification of Function, Disability and Health -Children and Youth Version ROM Range of motion AIM The aim of this study was to determine the effects of repeat botulinum toxin A (BoNT-A)injections in children with spastic cerebral palsy (CP) on the basis of a best evidence synthesis.METHOD This study included 13 original articles after searching the literature to retrieve information. We used the critical review form produced by McMaster University to determine the methodological quality of the studies, and then confirmed the levels of evidence from Sackett. The studies were also evaluated using the International Classification of Function, Disability and Health -Children and Youth Version (ICF-CY).RESULTS A total of 893 children with spastic CP who had been administered repeat BoNT-A injections were evaluated. The evidence level was II in four of the thirteen studies, III in four studies, and IV in five studies. The McMaster review form score was 14 in two studies, 13 in four studies, and 12 in seven studies. The results showed that repeat BoNT-A may be a safe and an effective approach. The first two injections/one repeat especially relieve spasticity and improve fine and gross motor activities.INTERPRETATION Future studies to investigate the effectiveness of repeat BoNT-A in children with spastic CP may be planned within the framework of the ICF-CY to include well-designed randomized controlled trials and those conducted on larger homogenous groups.Cerebral palsy (CP) is a neuromuscular pathology that is caused by an injury to the immature brain, and that limits activity by affecting the development of body function and posture. 1,2 CP is the most common childhood disability, and about 70% to 80% is of the spastic type.

Effectiveness of botulinum toxin type A for pain control in children with spastic cerebral palsy

“…As explained above, the findings of this study are consistent with the analgesic effects of Botulinum Toxin type A [22][23][24][25][26][27] , reinforcing the fact that it can be used for purposes other than spasticity, [28][29][30][31][32][33] or migraine 23 as they are the indications authorized by the FDA in Colombia at present 5 .…”

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

“…Also, to be cognizant that applying more than one intervention simultaneously might be beneficial to achieve a goal where multiple goal-limiting factors are present. If the goal is to improve functional mobility: a pharmacological agent to reduce background spasticity (green light) [185] might make it easier to learn to move. Similarly, increasing lower limb muscle strength via strength training (green light) may improve related strength and endurance [151,152], but principally targeted functional mobility training intervention will be required to establish an improvement in functional mobility (green light) [123,127].…”

“…Spasticity and dystonia cause involuntary movements and postures that affect motor control and can be painful. Our review identified that the following pharmacological agents and neurosurgical procedures effectively reduce spasticity: botulinum toxin [185], intrathecal baclofen [175,176], diazepam [3•], and selective dorsal rhizotomy [209] (green lights), plus dantrolene [3•] and tizanidine [3•] are probably effective (yellow light). Supplementary local injections of alcohol probably reduce spasticity [3] (yellow light, weak positive), and local injections of phenol also probably reduce spasticity very shortterm, but side effects are common (yellow light, weak negative) [195].…”

Effectiveness of multiple botulinum toxin sessions and the duration of effects in spasticity therapy in children with cerebral palsy

“…Long-term studies comparing the effects of BoNT treatment after each injection are rare [8]. Previous studies have shown that BoNT therapy is effective and therefore is currently a common clinical procedure in cerebral palsy [4–6].…”