Evaluation of a Multimodal Management of Prematurity-Related Spasticity

Papavasiliou, Antigone; Rapidi, Christina-Anastasia; Filiopoulos, Constantine; Rizou, Chrysoula; Skouteli, Helen

doi:10.1016/j.pediatrneurol.2006.08.003

Cited by 17 publications

(37 citation statements)

References 24 publications

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“…Table II regroups, under these four main outcomes of interest, participants in the included studies who were GMFCS levels IV and V and who showed a positive effect from the intervention. Reduction in muscle tone and improvements in ranges of motion were also shown in several studies (Table SII) 20,25–28,30,32–34,36,39 …”

Section: Resultsmentioning

confidence: 58%

“…Fourteen studies found positive results of BoNT‐A treatment on ease of positioning and care, improvements in GMFM scores or GMFCS levels, and motor function, such as transfer and assisted ambulation (Tables II and SII). In all studies in which statistical analyses were performed, statistical significance was achieved, 25,30,32,34,37 whereas those studies using descriptive measures reported marked improvement in gross motor function, standing, walking, ambulatory status, transfer, positioning, and ease of care 20,21,23,27,28,33,35,36,39 (Table SII). Three studies 25,35,36 used the GMFCS level to document changes in the gross motor function of the participants.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of the BoNT‐A in children with CP is dose dependent and varies with time intervals between injections 48 . All except two included studies 35,36 explicitly stated the injection dose and total dose used in the participants (Table SII). Two studies did not state which preparation of BoNT‐A was used 21,27 .…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review

Pin¹,

Elmasry²,

Lewis³

2012

Develop Med Child Neuro

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AIM Previous studies have shown the efficacy of botulinum toxin type A (BoNT-A) in the management of ambulant individuals with cerebral palsy (CP). There is little evidence on its use in nonambulant children with CP. This review aimed to investigate indications and efficacy for BoNT-A use in managing pain, care, and comfort, and improving function in children with CP in Gross Motor Function Classification System (GMFCS) levels IV and V.METHOD Electronic databases were searched from the earliest available date to June 2012 using a combination of subject headings and free text. Inclusion criteria consisted of studies with (1) participants aged 18 or under, (2) participants with CP in GMFCS levels IV and V, (3) participants receiving BoNT-A treatment, and (4) studies published in English-language peer-reviewed journals. RESULTSThe search resulted in a total of 814 studies, of which 19 met the inclusion criteria.Eighteen studies provided level IV or V evidence and one level I evidence according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for the development of systematic reviews. Most of the studies were of weak to moderate methodological quality.INTERPRETATION The evidence that BoNT-A is effective in reducing postoperative pain in children with CP in GMCFS levels IV and V is limited, with only one level I study identified. Remaining indications were general pain reduction, maintaining hip integrity, achieving functional changes, and goal attainment. A high percentage of participants in the studies showed positive changes in these areas. With the poor level of evidence of the included studies, no definite conclusion could be drawn on the indications for BoNT-A use in children with CP in GMCFS levels IV and V. Further investigation by rigorous studies is required.

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Section: Resultsmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review

Pin¹,

Elmasry²,

Lewis³

2012

Develop Med Child Neuro

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“…Higher and statistically significant gain was noted after the first injection in studies by Papavisilou et al [26] and Fattal-Valevski et al [25]. Also, in study by Read et al, a statistically significant gait improvement was especially marked after the first treatment and the effect was maintained also after two following treatments [27].…”

Section: Discussionmentioning

confidence: 97%

Effectiveness of multiple botulinum toxin sessions and the duration of effects in spasticity therapy in children with cerebral palsy

et al. 2018

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“…Botulinum toxin type A used as a treatment option in CP is considered to be safe, especially in ambulatory children [6,7]. Even though the experience of multiple groups has not produced serious adverse event rates that necessitated major changes in clinical practice the concern for adverse effects has been universal [8]. Worries about the safety of BoNT-A injections emerged particularly after 2005, when treatment with the toxin was associated with 28 deaths [9].…”

Section: Introductionmentioning

confidence: 99%

Safety of Botulinum Toxin A in Children and Adolescents with Cerebral Palsy in a Pragmatic Setting

Papavasiliou

Nikaina

Foska

et al. 2013

Toxins

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This retrospective study aimed to examine the safety of botulinum toxin A (BoNT-A) treatment in a paediatric multidisciplinary cerebral palsy clinic. In a sample of 454 patients who had 1515 BoNT-A sessions, data on adverse events were available in 356 patients and 1382 sessions; 51 non-fatal adverse events were reported (3.3% of the total injections number, 8.7% of the patients). On five occasions, the adverse reactions observed in GMFCS V children were attributed to the sedation used (rectal midazolam plus pethidine; buccal midazolam) and resulted in prolongation of hospitalization. Of the reactions attributed to the toxin, 23 involved an excessive reduction of the muscle tone either of the injected limb(s) or generalized; others included local pain, restlessness, lethargy with pallor, disturbance in swallowing and speech production, seizures, strabismus, excessive sweating, constipation, vomiting, a flu-like syndrome and emerging hypertonus in adjacent muscles. Their incidence was associated with GMFCS level and with the presence of epilepsy (Odds ratio (OR) = 2.74 − p = 0.016 and OR = 2.35 − p = 0.046, respectively) but not with BoNT-A dose (either total or per kilogram). In conclusion, treatment with BoNT-A was safe; adverse reactions were mostly mild even for severely affected patients. Their appearance did not necessitate major changes in our practice.

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Evaluation of a Multimodal Management of Prematurity-Related Spasticity

Cited by 17 publications

References 24 publications

Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review

Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review

Effectiveness of multiple botulinum toxin sessions and the duration of effects in spasticity therapy in children with cerebral palsy

Safety of Botulinum Toxin A in Children and Adolescents with Cerebral Palsy in a Pragmatic Setting

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