High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy
Identifieur interne : 000D67 ( Main/Merge ); précédent : 000D66; suivant : 000D68High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy
Auteurs : Allison. Willis ; Beth Crowner ; Janice. Brunstrom ; Abigail Kissel ; Brad. RacetteSource :
- Developmental medicine and child neurology [ 0012-1622 ] ; 2007.
Abstract
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%,
Url:
DOI: 10.1111/j.1469-8749.2007.00818.x
PubMed: 17979859
PubMed Central: 3064069
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<author><name sortKey="Willis, Allison W" sort="Willis, Allison W" uniqKey="Willis A" first="Allison" last="Willis">Allison. Willis</name>
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<author><name sortKey="Crowner, Beth" sort="Crowner, Beth" uniqKey="Crowner B" first="Beth" last="Crowner">Beth Crowner</name>
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<author><name sortKey="Brunstrom, Janice E" sort="Brunstrom, Janice E" uniqKey="Brunstrom J" first="Janice" last="Brunstrom">Janice. Brunstrom</name>
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<author><name sortKey="Kissel, Abigail" sort="Kissel, Abigail" uniqKey="Kissel A" first="Abigail" last="Kissel">Abigail Kissel</name>
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<author><name sortKey="Racette, Brad A" sort="Racette, Brad A" uniqKey="Racette B" first="Brad" last="Racette">Brad. Racette</name>
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<author><name sortKey="Crowner, Beth" sort="Crowner, Beth" uniqKey="Crowner B" first="Beth" last="Crowner">Beth Crowner</name>
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<author><name sortKey="Brunstrom, Janice E" sort="Brunstrom, Janice E" uniqKey="Brunstrom J" first="Janice" last="Brunstrom">Janice. Brunstrom</name>
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<author><name sortKey="Kissel, Abigail" sort="Kissel, Abigail" uniqKey="Kissel A" first="Abigail" last="Kissel">Abigail Kissel</name>
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<author><name sortKey="Racette, Brad A" sort="Racette, Brad A" uniqKey="Racette B" first="Brad" last="Racette">Brad. Racette</name>
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<series><title level="j">Developmental medicine and child neurology</title>
<idno type="ISSN">0012-1622</idno>
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<front><div type="abstract" xml:lang="en"><p id="P1">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%, <italic>n</italic>
=95), ambulation with a walker (27.6%, <italic>n</italic>
=72), and non-ambulatory (31.8%, <italic>n</italic>
=83). A few patients (4.2%, <italic>n</italic>
=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.</p>
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