Botulinum Toxin Injection as an Adjunct when Planning Hand Surgery in Children with Spastic Hemiplegia

Autti‐Rämö, Ilona; Larsen, Asger Væring; Peltonen, J.; Taimo, A; Wendt, Lennart von

doi:10.1055/s-2000-15289

Cited by 49 publications

(26 citation statements)

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“…In view of the small sample size, results were analysed individually and are summarized in Figures 1(a-f ) and 2(a-e) and Tables IV-VI. The parents recognized the tone reduction onset within a mean of 4.2 days (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14] and the decline after a mean of 3.4 months (range 1.5-5). All patients, parents and therapists reported relaxation, better posture and smoother movement patterns in the treated arm, this also being seen as change in MAS, ULPRS, caregiver satisfaction and cosmetic appearance scores.…”

Section: Resultsmentioning

confidence: 99%

“…The few studies investigating its clinical effectiveness on the spastic upper limb have shown a reduction in spasticity, increase in range of movement and improvement in function, cosmetic appearance and flexibility of movement pattern [7][8][9][10][11][12][13]. Outcome measurements have usually focused on impairment and grip function and, except for the latest studies, to a lesser extent on bimanual functions, self-care and daily activities.…”

Section: Introductionmentioning

confidence: 99%

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Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

Sätilä

Kotamäki

Koivikko

et al. 2006

Pediatric Rehabilitation

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The objective of this study was to investigate the effects of botulinum toxin A (BTXA) treatment on impairment and function of the upper limb during a 2-year follow-up period. A prospective longitudinal study design with assessments before and after intervention was utilized, involving six patients with cerebral palsy (three boys and three girls) aged 3 years 4 months to 11 years 11 months at commencement of study. The outcome measures were spasticity (modified Ashworth, MAS), active and passive range of movement (ROM), grips (pinch, key grip, 3-finger grip, narrow cylinder grip, wide cylinder grip, pen grip and diagonal grip; grasping, releasing; pronation-supination), bimanual functions, fine motor functions (Melbourne Assessment of Unilateral Upper Limb Function), movement pattern (Upper Limb Physician's Rating Scale, ULPRS), functional skills and self-care capability (Paediatric Evaluation of Disability Inventory, PEDI), upper extremity use (House Classification) and cosmetic appearance. The assessments were repeated by the same examiners at baseline and at 1, 3 and 6 months after each BTXA treatment and then every 6 months until 24 months. One subject received a total of four injections (at 0, 6, 12 and 18 months), one two injections (at 0 and 12 months) and four one injection at the beginning of the study period. Upper extremity surgery was performed on two subjects during the study and one was operated on 2 months after completion of the study. All children benefited from the BTXA treatment in terms of reduction in muscle tone and increase in active and passive ROM. By 6 months, spasticity returned, but in four children passive and especially active ROM remained better than at baseline. No significant changes in grips, bimanual tasks or Melbourne Assessment scores were detected. The change in movement pattern (ULPRS) was maintained for 3 months in two children and beyond this in four, thus extending beyond the pharmacologic effects of botulinum toxin A. All but one child showed improvement in PEDI functional skill and caregiver assistance scale scores during the 2-year period. The House classification showed a one-grade improvement in one child at 1 month and in one child at 3 months and a three-grade improvement in one child at 3 months after BTXA treatment. After each treatment, the parents reported at least a one-grade improvement in cosmetic appearance in all children at 1 month and in four children maintained at least until 6 months. In two subjects operated during the study period, a distinct improvement in active and passive ROM and a two-grade improvement in the House classification were observed after the operation. In this limited series, the reduction in muscle tone after BTXA treatment did not translate into better gripping or quality of fine motor functions (Melbourne Assessment) of the affected hand, but seemed to have a positive effect on upper limb movement pattern (ULPRS), upper extremity use (House Classification) and cosmetic appearance. Assessment of upper limb function in a child with ...

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

Sätilä

Kotamäki

Koivikko

et al. 2006

Pediatric Rehabilitation

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“…The high dose was in the range of BTX-A that is in current clinical usage and in published articles. 3,5,[7][8][9] The low-dose group received 50% of the dosage of the high-dose group for each muscle group injected. We hypothesized that a low dose would be more effective because it would permit a reduction in tone and subsequent improvement in function without causing significant weakness.…”

mentioning

confidence: 99%

A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity

Kawamura

Campbell

Lam-Damji

et al. 2007

Develop Med Child Neuro

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This study compared the effects of low and high doses of botulinum toxin A (BTX‐A) to improve upper extremity function. Thirty‐nine children (22 males, 17 females) with a mean age of 6 years 2 months (SD 2y 9mo) diagnosed with spastic hemiplegia or triplegia were enrolled into this double‐blind, randomized controlled trial. The high‐dose group received BTX‐A in the following doses: biceps 2U/kg, brachioradialis 1.5U/kg, common flexor origin 3U/kg, pronator teres 1.5U/kg, and adductor/opponens pollicis 0.6U/kg to a maximum of 20U. The low‐dose group received 50% of this dosage. Outcomes were measured at baseline and at 1 and 3 months after injection, and results were analyzed with a repeated‐measures analysis of variance. There was no significant difference between the low‐dose and high‐dose groups in upper extremity function over the 3‐month period as measured by the Quality of Upper Extremity Skills Test (F[1,37]=0.18, p=0.68). There was no difference between the groups in the Pediatric Evaluation of Disability Inventory Self Care Domain (F[1,37]=0.05, p=0.83). Although grip strength decreased over the 3‐month period, there was no difference between groups (F[1,32]=0.45, p=0.51). These findings indicate that there is no difference in hand and arm function between a low dose and a high dose of BTX‐A at 1 and 3 months after injection. This information can be used to guide dosage of BTX‐A for the management of upper extremity spasticity in children.

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“…However, there was no significant improvement of fine motor function for the entire group. Only a few open labelled trials are available [70][71][72]. The main clinical indication is for functional or cosmetic purposes, e.g.…”

Section: Review Of Botulinum Toxin In Treating Spasticity Of Upper LImentioning

confidence: 99%

“…This review attempts to analyse the current level of evidence in the use of Botox in treating lower limb or upper limb spasticity [67][68][69][70][71][72][73] and drooling [74][75][76][77]. Summary tables of most available Randomized Controlled Trials (RCT) and open labelled (OL) trials up to April 2003 are presented in tables 3-7.…”

Section: Introductionmentioning

confidence: 99%

Evidence-based approach of the use of Botulinum toxin type A (BTX) in cerebral palsy

Wong¹

2003

Pediatric Rehabilitation

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A systematic review with the Sachett model of evidence-based medicine of the use of Botulinum toxin type A (BTX) for intervention in children with Cerebral Palsy (CP) is highlighted. Currently, the evidence showed that BTX is useful for treating pes equinus due to spasticity of the gastrocnemius-soleus muscles. However, careful patient selection and goals of treatment have to be addressed. More multi-centre clinical trials with standardized protocols are needed before widespread recommendation of the use of BTX in treating spasticity in CP can be made.

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Botulinum Toxin Injection as an Adjunct when Planning Hand Surgery in Children with Spastic Hemiplegia

Cited by 49 publications

References 0 publications

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

Upper limb function after botulinum toxin A treatment in cerebral palsy: Two years follow-up of six cases

A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity

Evidence-based approach of the use of Botulinum toxin type A (BTX) in cerebral palsy

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