Analgesic Effects of Botulinum Toxin in Children with CP

Abstract

Experiencing pain is the greatest contributor to a reduced quality of life in children with cerebral palsy (CP). The presence of pain is quite common (~60%) and increases with age. This leads to missed school days, less participation, and reduced ambulation. Despite these alarming consequences, strategies to relieve the pain are absent and poorly studied. Moreover, it is difficult to evaluate pain in this group of children, especially in cases of children with cognitive deficits, and tools for pain evaluation are often inadequate. Botulinum toxin has been shown to alleviate pain in a variety of disorders and could potentially have an analgesic effect in children with CP as well. Even though most of the studies presented here show promising results, many also have limitations in their methodology as it is unlikely to capture all dimensions of pain in this heterogeneous group using only one assessment tool. In this review, we present a new way of examining the analgesic effect of botulinum toxin in children with CP using a variety of pain scores.

To switch from Botox to Dysport in children with CP, a real world, dose conversion, cost-effectiveness study

“…BoNT-A treatment can also relieve pain and ease of the care of non-ambulatory children most affected with no manual ability (GMFCS V, MACS V). Attenuation of pain through intramuscular injections of BoNT-A is believed to act both via reduction of spasticity and through alternative pharmacological pathways [161].…”

“…This absence of any BoNT-A treatment effect on arm usage for voluntary activity, could be due to muscle weakness and/or pain, another common side-effect following BoNT-A injections [158,159]. On the other hand, BoNT-A is also used to treat pain and in this context is believed to act both by directly reducing spasticity and through pharmacological pathways [161].…”

Time-matched accelerometers on limbs and waist in children with CP give new insights into real-life activities after botulinum toxin treatment: A proof of concept study

“…However, when assessing movements in daily life, it could not be verified that these goals were met, possibly due to weakness after the injections [23,24]. Despite this, many children and their caretakers ask for new injections roughly every 6 months, perhaps due to a feeling of becoming more at ease as a result of direct spasticity reduction and diminished co-contractions and mirror movements through alternative pharmacological pathways [36].…”

Acute and chronic pain in nonverbal children with neurological disorders. Possibilities of diagnosis and treatment. Systematic review

“…Однако это исследование и многие другие, показывающие хорошие результаты для БТА как средства от боли, имеют ограничения в отношении их методологии. Ограничения включают в себя отсутствие контрольной группы, исключение некоторых уровней GMFCS и измерение эффекта боли посредством использования только одного субъективного критерия [74].…”