Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy

Blumetti, Francesco Camara; Belloti, João Carlos; Tamaoki, Marcel Jun Sugawara; Pinto, José Antônio

doi:10.1002/14651858.cd001408.pub2

Cited by 49 publications

(77 citation statements)

References 127 publications

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“…All three AEs that were considered to be treatment-related occurred in the first treatment cycle. Previous research has suggested that BoNT treatment is less well tolerated in participants with GMFCS levels IV and V [21][22][23]. A substantial proportion (36.8%) of participants in our study had GMFCS levels IV and V; however, no safety concerns were noted.…”

Section: Discussioncontrasting

confidence: 55%

“…On the other hand, one of the main adverse effects reflected is the pain associated with the injection, which in our case is partially alleviated by the use of sedation during the procedure and by the instruction on pain management before injection. In opposition to this trial, in a recent Cochrane review, Blumetti [21] analyzed 31 studies that included a total of 1508 participants and concluded that the rate of adverse events with botulinum toxin use is similar to the rate obtained with placebo.…”

Section: Discussionmentioning

confidence: 99%

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IncobotulinumtoxinA for the treatment of spasticity in children with cerebral palsy – a retrospective case series focusing on dosing and tolerability

2020

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Background: IncobotulinumtoxinA (Xeomin®) is a botulinum neurotoxin type A with established efficacy in the treatment of upper-limb spasticity in adults. This retrospective case series in a university hospital setting aimed to elucidate the safety and tolerability of incobotulinumtoxinA for treatment of spasticity in children with cerebral palsy. Methods: Participants received incobotulinumtoxinA injections up to a maximum total dose of 600 U, 24 U/kg body weight. Medical records were reviewed for key demographic information, incobotulinumtoxinA exposure, and adverse effects (AEs). Results: Sixty-nine children were included (mean age [SD], 8.3 [3.9] years; 44/69 [63.8%] male). One-hundred-andninety-one injections were administered, with mean (SD) of 2.8 (1.5) treatment cycles/participant and dosing interval of 6.0 (1.7) months. The number of muscles injected increased from 2.4 (1.2) at cycle 1 to 4.2 (1.9) at cycle 6. The mean (SD) total incobotulinumtoxinA dose increased from 191.7 (126.2) U, (8.5 [5.4] U/kg body weight) at cycle 1 to 368.0 (170.1) U, (9.9 [5.5] U/kg body weight) at cycle 6. Seventy four adverse effects (37.5% of injections) were reported, the most frequent was injection pain (93.2% of AEs). Only three AEs were considered directly treatmentrelated by injectors: muscle weakness, generalized weakness, and fever. Conclusions:Our clinical experience indicates that incobotulinumtoxinA is a well-tolerated treatment option for focal spasticity in children with cerebral palsy. Trial registration: As the study was observational and retrospective, no EudraCT registration number was requested. The internal code assigned to the study in the administrative resolution was: 1143-N-15.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

IncobotulinumtoxinA for the treatment of spasticity in children with cerebral palsy – a retrospective case series focusing on dosing and tolerability

2020

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“…BTXA injection reduces the spasticity and increases the joint range but does not appear to decrease the passive intrinsic muscle stiffness or affect muscle compliance [102][103][104]. The first or subsequent injection, administered into the GC, was shown to increase the muscle length for a period of 12 to 24 weeks, as measured with three-dimensional gait analysis [105].…”

Section: What About the Muscles Of Children With Cp?mentioning

confidence: 99%

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Sätilä

2020

Toxins

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Botulinum toxin type A (BTXA) has been used for over 25 years in the management of pediatric lower and upper limb hypertonia, with the first reports in 1993. The most common indication is the injection of the triceps surae muscle for the correction of spastic equinus gait in children with cerebral palsy. The upper limb injection goals include improvements in function, better positioning of the arm, and facilitating the ease of care. Neurotoxin type A is the most widely used serotype in the pediatric population. After being injected into muscle, the release of acetylcholine at cholinergic nerve endings is blocked, and a temporary denervation and atrophy ensues. Targeting the correct muscle close to the neuromuscular junctions is considered essential and localization techniques have developed over time. However, each technique has its own limitations. The role of BTXA is flexible, but limited by the temporary mode of action as a focal spasticity treatment and the restrictions on the total dose deliverable per visit. As a mode of treatment, repeated BTXA injections are needed. This literature reviewed BTXA injection techniques, doses and dilutions, the recovery of muscles and the impact of repeated injections, with a focus on the pediatric population. Suggestions for future studies are also discussed.

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“…Botulinum toxin type A (BoNT-A) injection has been widely accepted as a safe and effective intervention to control lower limb spasticity in children with spastic CP [8][9][10]. According to a Cochrane review [11], the toxin injection into the lower limb in children with CP has a significant effect in tone reduction and spasticity reduction. In addition, there have been only several reports showing the changes in the parameters of computerized gait analysis, in which there was a significant improvement of ankle dorsiflexion at initial contact after the toxin injection into calf muscles [11].…”

Section: Introductionmentioning

confidence: 99%

“…According to a Cochrane review [11], the toxin injection into the lower limb in children with CP has a significant effect in tone reduction and spasticity reduction. In addition, there have been only several reports showing the changes in the parameters of computerized gait analysis, in which there was a significant improvement of ankle dorsiflexion at initial contact after the toxin injection into calf muscles [11]. However, to the best of our knowledge, the effect of BoNT-A injections into the hamstring on the muscle-tendon length and gait kinematics in children with FKG has been rarely studied [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Botulinum Toxin Type A Injections Impact Hamstring Muscles and Gait Parameters in Children with Flexed Knee Gait

Kim

Rha

Park

2020

Toxins

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The aim of this study was to determine if botulinum toxin type A (BoNT-A) injection into the medial hamstring can improve gait kinematics and muscle-tendon length in spastic cerebral palsy (CP) with a flexed knee gait (FKG). Twenty-nine children with spastic CP (Gross Motor Function Classification System I–III) with FKG were recruited for this prospective study. BoNT-A was injected into the semitendinosus and semimembranosus (SM) muscles under ultrasonography guidance. Assessments included Gross Motor Function Measure (GMFM), Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), 3-dimensional computerized gait analysis, calculated SM muscle-tendon length and lengthening velocity during gait using musculoskeletal modeling at baseline, 4 and 16 weeks after the injection. Compared to baseline data, significant improvements in GMFM, MAS, and MTS were demonstrated at weeks 4 and 16, and also a significant increase in maximum knee extension during the stance phase was observed at week 4. In addition, the mean lengthening velocity during the swing phase was increased at week 16 without a change in the SM muscle length. Furthermore, there was a significant increase in anterior pelvic tilt at week 4, compared to baseline data. The significant decrease in hip internal rotation after injection was observed only in children with excessive hip internal rotation at initial contact before injection. BoNT-A injection into hamstrings leads to a significant increase in knee extension and anterior pelvic tilt with an increase in lengthening velocity of SM in spastic CP with FKG.

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Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy

Cited by 49 publications

References 127 publications

IncobotulinumtoxinA for the treatment of spasticity in children with cerebral palsy – a retrospective case series focusing on dosing and tolerability

IncobotulinumtoxinA for the treatment of spasticity in children with cerebral palsy – a retrospective case series focusing on dosing and tolerability

Over 25 Years of Pediatric Botulinum Toxin Treatments: What Have We Learned from Injection Techniques, Doses, Dilutions, and Recovery of Repeated Injections?

Botulinum Toxin Type A Injections Impact Hamstring Muscles and Gait Parameters in Children with Flexed Knee Gait

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