Treatment of cerebral palsy: Use of botulinum neurotoxin type A free of complexing proteins (Xeomin®) in childhood

Objectives: Botulinum neurotoxin type A (BoNT A) is widely used in treatment of cerebral palsy (CP)1. Recently a preparation free of complexing proteins (Xeomin®) has been issued, but is not yet usable on-label in childhood.

Methods: Case-report. We show preliminary data of 6 children aged 4 to 17 years, suffering uni- or bilateral cerebral palsy (GMFCS level 1–5°). Patients got intramuscular injections of BoNT A in other formula before. Because of secondary decrease of effect preparation was changed to off-label-used BoNT A Xeomin®.

Results: Dosage applied was 10–76 MU/kg (max. 1.020 MU total), using multi-muscle-option. Injection was always performed while patients were in deep analgosedation using s-ketamin and midazolam (i.v. or rectal).

All patients showed good painrelief and decrease of spasticity after injection. No relevant sideeffects occurred.

Conclusions: In several conditions while treating children with spastic syndromes like CP we are in need for treatment-alternatives for conventional BoNT A (Botox®). BoNT free of complexing proteins (Xeomin®) is a possible alternative in cases when off-label-use is not a conditio-sine-qua-non, because Xeomin® seemed to bee as safe, dosage seemed to be equivalent to Botox®.

1 Heinen, F. eta al.: Botulinumtoxin für Kinder mit Zerebralparesen: 10-Punkte-Tabelle, 2007. Ein interdisziplinärer deutscher Konsensus. Monatsschr Kinderheilkd 2007; 155: 537–543.