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Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy.

Abstract
The efficacy of repeated botulinum toxin A (BTX-A) injections in two and three dose regimes, together with occupational therapy, on upper limb movement and function, was studied using an evaluator blinded, randomized, controlled two-group trial. Forty-two children (31 males, 11 females; range 2-8 y, mean 4 y [SD 1 y 7 mo]) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) longitudinally participated for 30 months, with the first 6 months reported earlier (Lowe et al. 2006). The BTX-A group (n=21) received three injections (0, 6, and 18 mo), while the delayed group had two (6 and 18 mo; dose 0.5-2.1 units/kg, mean 1.5 [SD 0.18]; dilution 100 units/0.5 ml). At 30 months, no difference existed between groups on any standardized measures. First and second injections showed significant treatment effect sizes, on Quality of Upper Extremity Skills Test (5.5 p=0.01: 4.5 p=0.03); parent Goal Attainment Scaling (GAS; 3.5 p=0.02: 3.9 p=0.01; therapist GAS 7.8 p=0.00: 4.0 p=0.03); Canadian Occupational Performance Measure (performance 0.4 p=0.05: 0.4 p=0.02; satisfaction 0.4 p=0.05: 0.37 p=0.08); and Pediatric Evaluation of Disability Inventory functional skills (1.8 p=0.00: 2.3 p=0.04). BTX-A was not linked to adverse events, suggesting repeated upper limb injections in children with hemiplegia receiving occupational therapy were safe and effective for improvement of movement and function.
AuthorsKevin Lowe, Iona Novak, Anne Cusick
JournalDevelopmental medicine and child neurology (Dev Med Child Neurol) Vol. 49 Issue 11 Pg. 823-9 (Nov 2007) ISSN: 0012-1622 [Print] England
PMID17979860 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Neuromuscular Agents
  • Botulinum Toxins, Type A
Topics
  • Botulinum Toxins, Type A (administration & dosage, adverse effects, therapeutic use)
  • Cerebral Palsy (drug therapy, physiopathology)
  • Child
  • Double-Blind Method
  • Female
  • Humans
  • Injections, Intramuscular
  • Male
  • Neuromuscular Agents (administration & dosage, adverse effects, therapeutic use)
  • Prospective Studies
  • Upper Extremity (physiopathology)

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