Neuropediatrics 2011; 42 - P034
DOI: 10.1055/s-0031-1274006

Unicentric cohortstudy in children with bilateral spastic cerebral palsy about the drop out reasons after the first treatment with botulinumtoxin within a multi-modal therapy concept

K Hinterstoißer 1, AS Schröder 1, C Jansen 1, K Huß 1, I Borggraefe 1, F Heinen 1, S Berweck 2
  • 1Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, München, Germany
  • 2Schön Klinik Vogtareuth, Neuropädiatrie und Neurologische Rehabilitation, Epilepsiezentrum für Kinder und Jugendliche, Tagesklinik für Neuropädiatrie, Vogtareuth, Germany

Introduction: Multi-level treatment with botulinum toxin type A (BoNT/A; Botox®) plays a central role within the integrative treatment strategy in children with cerebral palsy (CP). Goal of this study was to analyse the reasons for continuing treatment with BoNT/A after the first injection.

Methods: Prospective data analysis from January 2004- December 2009at the Dr. v. Hauner's Chidren's Hospital of the University of Munich. Demographic parameters (gender, age, body weight, GMFCS) as well as drop out reasons were assessed for different subgroups. Cohort A=only one treatment versus Cohort B=more than one treatment with BoNT/A were analysed separately.

Results: 103 patients with bilateral spastic CP were analysed. Cohort A (n=26), age: 6,8 years (median; min-max: 2,0–23,8), body weight 21kg, most frequent GMFCS level: 3 (median; mean 3,3, standard deviation 1,33, range 1–5), previous operation: 7,6%. Most common reasons for discontinuing with injection of BoNT/A were indication for surgery (35% of cases) and failure to achieve therapy goal (11%). Cohort B (n=77), age: 3,6 years (median; min-max: 1,4–22,0), body weight 18kg, most frequent GMFCS level: 3 (median; mean 2,7, standard deviation 1,25, range 1–5), previous operation: 9,1%. Indication for surgery was a drop out reason in 23%. There was no difference in the dispersion of gender between the two groups: m: 62% versus 65% (Cohort A v. Cohort B).

Conclusion: The results show similar reasons for discontinuation (25%) as already published data (Linder-Lucht et al. 2006) however they focus on demographic parameters: higher age, body weight and GMFCS level cause worse therapeutic response in the first treatment with BoNT/A. This should be regarded in the early years of groß motor development in children with CP when planning intervention with BoNT/A within a long-term integrative treatment strategy.