European consensus table 2006 on botulinum toxin for children with cerebral palsy

Heinen, Florian; Molenaers, Guy; Fairhurst, Charlie; Carr, Lucinda; Desloovere, Kaat; Valayer, Emmanuelle Chaleat; Morel, É.; Papavassiliou, Antigone S.; Tedroff, Kristina; Pascual, Pascual; Bernert, G.; Berweck, Steffen; Rosa, Giuseppe Di; Kolanowski, Elisabeth; Krägeloh‐Mann, Ingeborg

doi:10.1016/j.ejpn.2006.08.006

Cited by 100 publications

(74 citation statements)

References 130 publications

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“…16 This is in contrast to studies which demonstrate the efficacy and safety of BTX-A, and support its use in the pediatric population. 17 Our retrospective analysis of open label use of BTX-A investigated the safety of higher dose BTX-A injections in commonly encountered clinical scenarios in children with CP. Previously published studies have used relatively low doses of BTX-A for concern of causing serious systemic AEs, and it is possible that this has led to inadequate treatment in recent studies.…”

Section: Discussionmentioning

confidence: 99%

High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy

Willis

Crowner

Brunstrom

et al. 2007

Develop Med Child Neuro

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The aim of this study was to determine the safety profile of high dose (15-25 units/kg) of botulinum toxin A (BTX-A) in children with cerebral palsy (CP) and increased lower extremity muscle tone. We performed a retrospective review of 929 patient encounters at the Movement Disorders Center at Washington University. A total of 261 patients (105 females; 156 males) were treated during these visits, ages 6 months to 21 years (mean 8y 4mo [SD 4y 8mo]). Ambulatory ability at the time of BTX-A injection was independent ambulation (36.4%, n=95), ambulation with a walker (27.6%, n=72), and non-ambulatory (31.8%, n=83). A few patients (4.2%, n=11) were able to ambulate with a cane or crutch at the time of injection. Participants were characterized according to BTX-A dose, CP etiology, motor involvement pattern, muscles injected, ambulatory ability, and use of oral tone medications. Follow-up records were searched for reported adverse events (AEs), with a mean time to AE assessment of 6.5 weeks (SD 3.38). The AE occurrence was determined for doses of 0 to 4.9 units/kg, 5 to 9.9 units/kg, 10 to 14.9 units/kg, 15 to 19.9 units/kg, and 20 to 25 units/kg. The overall AE occurrence was 4.2%. Standard doses of BTX-A had side-effect occurrences of 3.9% for 5 to 10 units/kg and 7.6% for 10 to 15 units/kg. Among higher doses (15-20 units/kg and 20-25 units/kg) the AE occurrence was 3.5% and 8.6% respectively. No patient developed botulism. AEs were randomly distributed across dosing groups, CP etiologies, clinical phenotypes, ambulatory status, and treatment duration. All doses were associated with a significant increase in passive range of motion using the Tardieu scale. We conclude that higher dose BTX-A is safe in children with a spectrum of CP phenotypes and are well tolerated over time.Cerebral palsy (CP) is a common neurological condition causing cognitive and motor disability in a large percentage of children born preterm. 1 The positive (increased tendon jerks and clonus) and negative (limitation of range of motion, joint deformity, and contracture) symptoms of spasticity found in CP are theorized to occur via chronic hyperactivity of the spinal reflex. Botulinum toxin A (BTX-A) is a potent neurotoxin produced by the bacterium clostridium botulinum that causes reversible chemodenervation by irreversibly binding to the acetylcholine receptor at the neuromuscular junction. Botulinum toxin presumably relieves the symptoms of spasticity by disrupting the hyperactive spinal reflex at the level of the neuromuscular junction.Despite numerous studies demonstrating efficacy and safety of botulinum neurotoxin A in children, many patients have unmet tone needs and it is unclear if higher doses of BTX-A can be safely used. The efficacy of BTX-A injection for children with CP and excessive lower extremity tone has been demonstrated in several placebo-controlled studies with joint range of motion as the primary outcome measure. [2][3][4]

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Section: Discussionmentioning

confidence: 99%

High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy

Willis

Crowner

Brunstrom

et al. 2007

Develop Med Child Neuro

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“…Диапазон доз диспорта, рекомендованных по-следним Европейским консенсусом по применению препаратов ботулинического токсина для детей с ДЦП [19], составляет 1-20 ЕД/кг массы тела, а в ря-де случаев может достигать 25 Ед/кг массы тела [3]. Максимальная общая доза диспорта должна нахо-диться в пределах 500-1000 Ед, а максимальная до-за, вводимая в одну точку, должна составлять 50 -250 Ед.…”

Section: Discussionunclassified

Selection of a dose of the botulinum toxin A in spastic forms of cerebral palsy

Куренков

Клочкова

Каримова

et al. 2015

Z. nevrol. psikhiatr. im. S.S. Korsakova

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“…Injections into muscles of upper extremities and profound muscles of lower extremities were conducted under ultrasound visualization control using an ultrasound diagnostic apparatus Accuvix V20 Prestige (Samsung Medison) with a linear sensor (frequency -10-12 MHz) in the mode of visualization of musculoskeletal and superficial soft-tissue structures. Calculating BTA dosage, we observed recommendations of the European consensus on the use of botulinum therapy for children with CP [22], according to which the safe dose of the drug is 1-20 (25) IU/kg (according to data of several other studies, up to 30 IU/kg [23][24][25]), maximum total dose -500-1,000 IU; maximum dose per injection site -50-250 IU. The drug's dose calculation for each target muscle for each injection was conducted on an individual basis given the child's age and weight, target muscle's volume and intensity of spasticity and general motor disorders.…”

Section: Methodsmentioning

confidence: 99%

Spasticity Patterns of Hand Muscles and Botulinum Toxin Therapy Application in Patients With Cerebral Palsy With Upper Limb Involvement

et al. 2013

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European consensus table 2006 on botulinum toxin for children with cerebral palsy

Cited by 100 publications

References 130 publications

High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy

High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy

Selection of a dose of the botulinum toxin A in spastic forms of cerebral palsy

Spasticity Patterns of Hand Muscles and Botulinum Toxin Therapy Application in Patients With Cerebral Palsy With Upper Limb Involvement

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