Effect of Botulinum Toxin Type A on Cerebral Palsy with Upper Limb Spasticity

Yang, Tsui Fen; Fu, Chung Pei; Kao, Nien Tzu; Chan, Rai-Chi; Chen, Shu Jen

doi:10.1097/01.phm.0000056989.67763.07

Cited by 58 publications

(44 citation statements)

References 24 publications

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“…Furthermore, spasticity is a major risk for secondary articular damage: contractures, pain and vitiated postures. Spasticity can be relieved by means of systemic and local drug treatments; in particular botulinum toxin (BT) has been much used to manage spasticity in several anatomical areas in a variety of conditions such as multiple sclerosis [10,27,44,50], cerebral palsy [17,20,28,41,58], and traumatic brain injury [49,57]. BT plays a role in the management of upper and lower limb spasticity also in hemiparetic patients after stroke [7,11,25,35,43,47,51,59].…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

Miscio

Conte

Pianca

et al. 2004

Journal of Neurology

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Section: Introductionmentioning

confidence: 99%

Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

Miscio

Conte

Pianca

et al. 2004

Journal of Neurology

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“…However, with regard to arm-hand function in children with cerebral palsy (CP), a recent systematic review concluded that there is very little evidence to guide the choice of treatment (Boyd et al 2001). Beside some uncontrolled studies (Wall et al 1993, Hurvitz et al 2003, Yang et al 2003, only two small randomized studies of BTX-A in the treatment of arm function problems in children with CP have been published. In a randomized, doubleblind placebo-controlled study describing the effects of BTX-A injections into the upper limb in 14 patients with CP, Corry et al (1997) found a significant increase in active elbow and thumb extension, and a significantly reduced tone at wrist and elbow, at 12-week follow-up.…”

mentioning

confidence: 99%

Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy

Speth¹,

Leffers²,

Janssen-Potten³

et al. 2007

Developmental Medicine &Amp; Child Neurology

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The objective of this study was to determine whether the use of intramuscular botulinum toxin A (BTX‐A) increases upper limb function and skills in the context of a specific therapy programme in children with hemiparetic cerebral palsy. Twenty children (nine females, 11 males) aged 4 to 16 years who were thought likely to benefit from BTX‐A treatment were included. After matched pairs were made, on the basis of Zancolli grade and age, randomization took place. All patients were given structured rehabilitation (physiotherapy and occupational therapy three times a week for 6 months), and half of the patients received intramuscular BTX‐A. No placebo injections were given in the control group. Participants were assessed at baseline, at 2 and 6 weeks, and at 3, 6, and 9 months after injection. The Ash worth scale, active range of motion of arm joints, the Melbourne assessment of upper limb function, the Pediatric Evaluation of Disability Inventory, and the nine‐hole peg test were used for outcome measurement. Observers were blinded for treatment allocation only for scoring the Melbourne test. The children in the treatment group showed a clinically relevant increase in active dorsal flexion, and tone reduction of the wrist. For the functional outcome measures, no statistically significant differences between the groups could be demonstrated. Intramuscular BTX‐A added to an intensive therapy programme reduces impairment for at least 9 months; the effect on activity level is still uncertain.

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“…BTX-A injections have previously been identified as a safe treatment in CP with side-effects in the upper limb being few, minor, and transient, [5][6][7]21,22 and occurring more often with high doses. 10 …”

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] Occupational or physical therapy is usually provided with BTX-A. Occupational therapy has been found to be effective in enhancing functional outcomes in the upper limbs of children with CP who received BTX-A.…”

mentioning

confidence: 99%

Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy

Lowe

Novak

Cusick

2007

Develop Med Child Neuro

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The efficacy of repeated botulinum toxin A (BTX‐A) injections in two and three dose regimes, together with occupational therapy, on upper limb movement and function, was studied using an evaluator blinded, randomized, controlled two‐group trial. Forty‐two children (31 males, 11 females; range 2–8y, mean 4y [SD 1y 7mo]) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) longitudinally participated for 30 months, with the first 6 months reported earlier (Lowe et al. 2006). The BTX‐A group (n=21) received three injections (0, 6, and 18mo), while the delayed group had two (6 and 18mo; dose 0.5‐2.1 units/kg, mean 1.5 [SD 0.18]; dilution 100 units/0.5ml). At 30 months, no difference existed between groups on any standardized measures. First and second injections showed significant treatment effect sizes, on Quality of Upper Extremity Skills Test (5.5 p=0.01: 4.5 p=0.03); parent Goal Attainment Scaling (GAS; 3.5 p=0.02: 3.9 p=0.01; therapist GAS 7.8 p=0.00: 4.0 p=0.03); Canadian Occupational Performance Measure (performance 0.4 p=0.05: 0.4 p=0.02; satisfaction 0.4 p=0.05: 0.37 p=0.08); and Pediatric Evaluation of Disability Inventory functional skills (1.8 p=0.00: 2.3 p=0.04). BTX‐A was not linked to adverse events, suggesting repeated upper limb injections in children with hemiplegia receiving occupational therapy were safe and effective for improvement of movement and function.

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Effect of Botulinum Toxin Type A on Cerebral Palsy with Upper Limb Spasticity

Cited by 58 publications

References 24 publications

Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy

Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy

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