Interventional-neuropaediatric spectrum of treatments with botulinum neurotoxin type A, free of complexing proteins: Effective and safe application – Three exemplary cases

Introduction: Use of botulinum neurotoxin type A (BoNT/A), preparation Xeomin®, free of complexing proteins in (1) bilateral spastic cerebral palsy (BS-CP), (2) lower limb dystonia and (3) sialorrhea: efficacy and safety of the application in three patients in complex neuropaediatric supply.

Methods and results: Clinical course of three exemplary patients, who have been treated with botulinum neurotoxin type A (BoNT/A), preparation Xeomin®: Patient 1 (female patient, 17 years old, BS-CP, GMFCS level 1, dosage/session: 6 MU/kg BW, 2 sessions, treatment of Mm. rectus femores and robotic-assisted treatmill training in an observation period of 17 month): Pharmacotherapeutic modulation of antagonistic muscles by reducing muscle tone with BoNT/A and site-directed activity by strenghthening muscles with robotic-assisted treadmill training with the Driven Gait Orthesis Lokomat® lead to improvement of 7.9% in bilateral spastic CP measured by Gross Motor Function Measure (GMFM-66). Patient 2 (male patient, 17 years old, lower limb dystonia, dosage/session: 4 MU/kg BW, 5 sessions, treatment of toe flexors): The additive focal use of BoNT/A with the aim to optimize deep brain stimulation of overriding importance enables walking ability. Patient 3 (female patient, 24 years old, BS-CP, GMFCS level 5, intraglandular injection of a total of 3.25 MU Xeomin®/kg BW after decreasing effect of the treatment with BoNT/B): noticeable reduction of salivary production in drooling caused by swallowing impairment in CP. Constipation might be a distant effect, adverse systemic or local effects have not been observed.

Conclusion: Xeomin®, arises from the considerations of these complex, exemplary patients to an effective and safe BoNT/A preparation for multimodal neuropaediatric therapeutic strategies and appears to affirm the positive experiences of adults' neurology.