Cerebral palsy and bruxism: Effects of botulinum toxin injections—A randomized controlled trial

Abstract

ObjectiveCerebral palsy (CP) includes disturbances in muscular control caused by perinatal brain injury. Masticatory muscle involvement hampers functions such as chewing and talking. Bruxism and temporomandibular disorders are overrepresented. Neuromuscular blocks with botulinum toxin type A (BTX‐A) may alleviate problems due to muscular hyperactivity. The aim was to evaluate masticatory muscle BTX‐A injections in subjects with CP and bruxism.MethodsA prospective, parallel, randomized, placebo‐controlled, and double‐blind trial in 12 patients with CP was performed. End points were alterations in objective and subjective oral capacities after two BTX‐A or corresponding placebo injections. Matched, healthy references were also evaluated.ResultsThe reference group demonstrated stronger and more efficient oral functions compared with the CP group. Subjective and objective oral capacities appeared to vary considerably between CP patients and also over time in this patient group and were poorly correlated. No significant effect of BTX‐A compared with placebo on outcome variables was observed at group level, but continued treatment with BTX‐A was requested by the majority of the patients.ConclusionThe evidence is unable to support the use of BTX‐A for the treatment of affected masticatory muscles in CP, but the findings are inconclusive in certain respects. Larger, more homogeneous groups of CP patients need to be evaluated in future trials.

Adverse events after different forms of botulinum neurotoxin A injections in children with cerebral palsy: An 8‐year retrospective study

“…Previous studies have proved the efficacy of the two BoNT-A formulations in children with CP. 23,28,29 The tendency to choose Onabotulinumtoxin-A indicated that many caregivers The number of adverse events divided by the number of injections (1013 Onabotulinumtoxin-A injections, 418 Lanbotulinumtoxin-A injections).…”

“…Interestingly, we noticed that more families chose Onabotulinumtoxin‐A rather than Lanbotulinumtoxin‐A, even though the latter is much cheaper. Previous studies have proved the efficacy of the two BoNT‐A formulations in children with CP 23,28,29 . The tendency to choose Onabotulinumtoxin‐A indicated that many caregivers have less confidence in the safety of Lanbotulinumtoxin‐A than Onabotulinumtoxin‐A to a certain extent.…”

Toxina botulínica vs otros métodos alternativos como opción para el tratamiento de pacientes con bruxismo: Revisión sistemática

“…A propósito de la dosis y lugar de punción del botox, no se ha evidenciado hasta la fecha una norma de la cantidad máxima para el tratamiento del bruxismo, debido a que la literatura reporta que el producto es comercializado en distintas disoluciones (Weill Medical College of Cornell University, 2021). Tampoco se ha establecido el número de punciones ni el mejor sitio en el que se obtengan mejores resultados; esto se puede corroborar en nuestra revisión, puesto que en ciertos artículos el sitio de las punciones van en un rango de 2 a 7 (Ondo et al, 2018) (Ali et al, 2021) (Yurttutan et al, 2019) pero en otras investigaciones no se detalla la cantidad exacta de punciones realizadas (Cahlin et al, 2019) (Shim et al, 2020). De la misma manera, no se ha establecido si existe mayor efectividad al colocar en el músculo masetero o temporal; en base a esto, 4 de los 6 artículos incluidos en la revisión aplicaron 100U de BTX en total; en otras palabras, en el músculo masetero y temporal de manera bilateral.…”

Prevalence of bruxism in adults with cerebral palsy institutionalized in Lisbon

“…3,14,15 Several factors have been pointed out to justify the high prevalence of bruxism in this population, such as myofunctional disorder, hyperactivity of the muscles of the masticatory system, the inherent neurological changes and even disturbances in dopaminergic function. [15][16][17] One limitation found was the variability of diagnostic criteria and the lack of associated specificity, suggesting that studies need greater standardization of diagnostic protocols. Specifically in SB, the prevalence in this study was 14.5%, being lower than the results achieved in a similar Portuguese population, whose value was 28.8%.…”