Prospective study examining remote effects of botulinum toxin a in children with cerebral palsy

Document Type

Article

Abstract

We examined the remote effects on muscle strength and functional decline of lower-extremity botulinum toxin A injections in children with cerebral palsy. This prospective study enrolled 34 children (19 boys, 15 girls; mean age, 7.7 years) diagnosed with spastic cerebral palsy. Patients were examined at baseline and 1 month to determine if they experienced a change in upper-extremity strength (handheld dynamometry) or function (Pediatric Outcomes Data Collection Instrument). Subjects were analyzed in aggregate and by dosing group (low dose, 0-10 U/kg body weight; high dose, 11-25 U/kg) to determine if injection dose was associated with a change in remote muscle strength or function. We measured baseline and 1-month postinjection strength in shoulder flexor, shoulder abductor, elbow flexor, elbow extensor, and finger flexor muscles. None of these remote muscle groups was significantly weaker at 1 month after injection. No correlation was evident between change in muscle strength and toxin dose. These findings indicate that doses of botulinum toxin A in the lower extremities, at up to 21 U/kg, do not affect upper-extremity strength. This information can help guide dosages of botulinum toxin A in the management of spasticity in children with cerebral palsy.

Medical Subject Headings

Adolescent; Botulinum Toxins, Type A (administration & dosage, therapeutic use); Brain Damage, Chronic (drug therapy, physiopathology); Cerebral Palsy (drug therapy, physiopathology); Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Lower Extremity; Male; Motor Skills (drug effects, physiology); Muscle Spasticity (drug therapy, physiopathology); Muscle Strength (drug effects, physiology); Muscle, Skeletal (drug effects, physiopathology); Neurologic Examination (methods); Neuromuscular Agents (administration & dosage, therapeutic use); Prospective Studies; Treatment Outcome; Upper Extremity

Publication Date

10-1-2008

Publication Title

Pediatric neurology

ISSN

0887-8994

Volume

39

Issue

4

First Page

253

Last Page

8

PubMed ID

18805363

Digital Object Identifier (DOI)

10.1016/j.pediatrneurol.2008.07.003

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