Treatment with Botulinum toxin A in a total population of children with cerebral palsy - a retrospective cohort registry study

Abstract

BackgroundBotulinum toxin A (BTX-A) has been used to reduce spasticity in children with cerebral palsy (CP) for decades. The purpose of this study was to analyze to what extent BTX-A treatment was used to treat spasticity in a total population of children with CP. We investigated 1) the use of BTX-A in relation to age, sex, and Gross Motor Function Classification System (GMFCS) level, 2) the most common muscle groups treated with BTX-A in relation to the same variables, and 3) changes in the proportions of children treated with BTX-A between two time points (2010 and 2015).MethodsThe study was based on data from CPUP, a combined Swedish follow-up program and national healthcare registry, comprising >95% of all children with CP in Sweden. The participants (N = 3028) were born in 2000 or later. Potential BTX-A treatment and treated muscle groups were included from all CPUP assessments recorded in the registry in 2014–2015. In Aim 3, BTX-A administration in 3–5 year-olds at two time points was assessed. Crosstabs and 95% confidence intervals (CIs) for binominal proportions were calculated and logistic regression was used to regress age, sex, and GMFCS level on BTX-A treatment. Muscle groups treated with BTX-A were assessed using crosstabs and 95% CIs. Proportional change in BTX-A treatment over a 5-year period was analyzed using chi-square.ResultsWe included 3028 children (57% boys; median age 7 years) of whom 26% received BTX-A. Significantly more boys (28%) than girls (23%) received BTX-A (OR = 1.25, [95% CI 1.05–1.48]). Significant differences were found for age and GMFCS levels; 4–6 year-olds and those at GMFCS III-IV were more likely to receive BTX-A. BTX-A treatment in the gastrocnemius muscle was most common in the 4–6 year-olds and at GMFCS I-III, whereas treatment of the hamstring and adductor muscles was more common in older children and at GMFCS IV-V. No significant change in the proportion of BTX-A administered in 2010 and 2015 was demonstrated.ConclusionsBTX-A treatment differed based on age, sex, and GMFCS level. Proportion of BTX-A treatment in Sweden has remained stable during the past five years.Electronic supplementary materialThe online version of this article (10.1186/s12891-017-1880-y) contains supplementary material, which is available to authorized users.

Gender differences in treatments and interventions received by children and adolescents with cerebral palsy

“…In a previous population based study on the use of BTX-A, significantly more boys (28%) than girls (23%) received BTX-A (OR = 1.25 [95% CI 1.05-1.48]) [22]. Our current research did not find support for this finding after controlling for GMFCS level, age and spasticity.…”

“…In CPUP, there is a slight male predominance at all levels of GMFCS (with the exception of level II), at all levels of MACS and for all CP subtypes (with the exception of ataxic CP), which is in line with corresponding data from other national registries [19][20][21]. In two recently published studies based on CPUP data, study authors noted gender differences on treatments received [22,23]. One of the studies included CPUP data from five northern counties in Sweden, and based on univariate analyses, in three of the five counties girls received less physiotherapy (PT) and less often than boys.…”

“…Furthermore, boys participated more frequently in physical education than girls [23]. The other study included CPUP data from all of Sweden, and results showed that boys were significantly more likely than girls to have received botulinum toxin A (BTX-A) since their last CPUP-assessment [22]. The gender of the caregivers and children have been reported by other researchers not to affect the caregivers' treatment acceptability of BTX-A injections in children with CP [24].…”

Gender Differences in Treatments and Interventions Received for Children and Adolescents with Cerebral Palsy

“…In CPUP, there is a slight male predominance at all levels of GMFCS (with the exception of level II), at all levels of MACS and for all CP subtypes (with the exception of ataxic CP), which is in line with corresponding data from other national registries (19)(20)(21). In two recently published studies based on CPUP data, study authors noted gender differences on treatments received (22,23). One of the studies included CPUP data from five northern counties in Sweden, and based on univariate analyses, in three of the five counties girls received less physiotherapy and less often than boys.…”

Bruk av botulinumtoksin A til barn med cerebral parese

“…Andelen barn behandlet med botulinumtoksin A i vår studie er høy sammenlignet med en nylig svensk studie som fant at bare ca. en tredel av barna i et nasjonalt oppfølgingsprogram hadde blitt behandlet ved 4-6 års alder (13). Vi kjenner ikke til andre studier der man har sett på hyppigheten av botulinumtoksin A-behandling i en total populasjon av barn med cerebral parese.…”