Download PDF
Neuropediatrics 2020; 51(01): 001-005
DOI: 10.1055/s-0039-1694988
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Botulinum Toxin in Children with Cerebral Palsy: An Update

Farid Hareb
1   Clinique “Les Cadrans Solaires,” 11 Route de Saint-Paul, 06140, Vence, France
,
Carlo M. Bertoncelli
2   Fondation Lenval EEAP “H. Germain,” 337 Les Provençales de Ginestière, Nice, France
,
Olivier Rosello
3   Pediatric Orthopaedic Surgery, Fondation Lenval, 57 Avenue Californie, Nice, France
,
Virginie Rampal
3   Pediatric Orthopaedic Surgery, Fondation Lenval, 57 Avenue Californie, Nice, France
,
Federico Solla
3   Pediatric Orthopaedic Surgery, Fondation Lenval, 57 Avenue Californie, Nice, France
› Author Affiliations
Further Information

Publication History

02 May 2019

12 June 2019

Publication Date:
04 September 2019 (online)

Also available at
   Permissions and Reprints

Abstract

Injected in a muscle, the botulinum toxin causes localized and temporary paralysis by acting on the neuromuscular synapse. Currently, it is widely prescribed for the treatment of limb spasticity in children from the age of 2 years. Combined with rehabilitation and other treatments, it helps to progress in motor learning, promotes functional progression, and delays orthopaedic degradations.

Numerous randomized, placebo-controlled studies have shown efficacy in reducing spasticity, improving passive and active mobility, reducing pain, and improving upper limb comfort care. The side effects are rare and commonplace.

The injection technique is accessible after specific training and practice. The indication is better evaluated by a multidisciplinary team. A precise clinical evaluation, assisted by an instrumental analysis (videography, spatiotemporal parameters, kinematics, kinetics, and electromyography), makes it possible to determine the aims of the treatment and to evaluate the outcome.

The objective of this review is to present current evidence base and practices regarding the use of botulinum toxin in children with cerebral palsy.

Keywords

botulinum toxin - children - cerebral palsy - spasticity

Financial support

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


 

  • References

  • 1 Burgen AS, Dickens F, Zatman LJ. The action of botulinum toxin on the neuro-muscular junction. J Physiol 1949; 109 (1-2): 10-24
    CrossrefPubMedGoogle Scholar
  • 2 Meunier FA, Schiavo G, Molgó J. Botulinum neurotoxins: from paralysis to recovery of functional neuromuscular transmission. J Physiol Paris 2002; 96 (1-2): 105-113
    CrossrefPubMedGoogle Scholar
  • 3 Brochard S, Blajan V, Lempereur M. , et al. Determining the technical and clinical factors associated with pain for children undergoing botulinum toxin injections under nitrous oxide and anesthetic cream. Eur J Paediatr Neurol 2011; 15 (04) 310-315
    CrossrefPubMedGoogle Scholar
  • 4 Ben-Pazi H, Cohen A, Kroyzer N. , et al. Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections - a quasi-randomized controlled crossover study. PLoS One 2017; 12 (04) e0175028 . Doi: 10.1371/journal.pone.0175028. eCollection 2017.
    CrossrefPubMedGoogle Scholar
  • 5 Alter KE, Karp BI. Ultrasound guidance for botulinum neurotoxin chemodenervation procedures. Toxins (Basel) 2017; 10 (01) E18
    CrossrefPubMedGoogle Scholar
  • 6 Pitcher CA, Elliott CM, Panizzolo FA, Valentine JP, Stannage K, Reid SL. Ultrasound characterization of medial gastrocnemius tissue composition in children with spastic cerebral palsy. Muscle Nerve 2015; 52 (03) 397-403
    CrossrefPubMedGoogle Scholar
  • 7 Traitement médicamenteux de la spasticité, recommandations de bonne pratique. French Agency for Drugs Security 2011 http://ansm.sante.fr/var/ansm_site/storage/original/application/a79f07eee915181bc9ae4e506140cecb.pdf Accessed 25 June 2018.
    PubMedGoogle Scholar
  • 8 Gonnade N, Lokhande V, Ajij M, Gaur A, Shukla K. Phenol versus botulinum toxin A injection in ambulatory cerebral palsy spastic diplegia: a comparative study. J Pediatr Neurosci 2017; 12 (04) 338-343
    CrossrefPubMedGoogle Scholar
  • 9 Juneja M, Jain R, Gautam A, Khanna R, Narang K. Effect of multilevel lower-limb botulinum injections & intensive physical therapy on children with cerebral palsy. Indian J Med Res 2017; 146 (Supplement): S8-S14
    PubMedGoogle Scholar
  • 10 Barwood S, Baillieu C, Boyd R. , et al. Analgesic effects of botulinum toxin A: a randomized, placebo-controlled clinical trial. Dev Med Child Neurol 2000; 42 (02) 116-121
    CrossrefPubMedGoogle Scholar
  • 11 Baker R, Jasinski M, Maciag-Tymecka I. , et al. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study. Dev Med Child Neurol 2002; 44 (10) 666-675
    PubMedGoogle Scholar
  • 12 Bjornson K, Hays R, Graubert C. , et al. Botulinum toxin for spasticity in children with cerebral palsy: a comprehensive evaluation. Pediatrics 2007; 120 (01) 49-58
    CrossrefPubMedGoogle Scholar
  • 13 Fazzi E, Maraucci I, Torrielli S, Motta F, Lanzi G. Factors predicting the efficacy of botulinum toxin-A treatment of the lower limb in children with cerebral palsy. J Child Neurol 2005; 20 (08) 661-666
    CrossrefPubMedGoogle Scholar
  • 14 Hawamdeh ZM, Ibrahim AI, Al-Qudah AA. Long-term effect of botulinum toxin (A) in the management of calf spasticity in children with diplegic cerebral palsy. Eura Medicophys 2007; 43 (03) 311-318
    PubMedGoogle Scholar
  • 15 Lee LR, Chuang YC, Yang BJ, Hsu MJ, Liu YH. Botulinum toxin for lower limb spasticity in children with cerebral palsy: a single-blinded trial comparing dilution techniques. Am J Phys Med Rehabil 2004; 83 (10) 766-773
    CrossrefPubMedGoogle Scholar
  • 16 Bottos M, Benedetti MG, Salucci P, Gasparroni V, Giannini S. Botulinum toxin with and without casting in ambulant children with spastic diplegia: a clinical and functional assessment. Dev Med Child Neurol 2003; 45 (11) 758-762
    PubMedGoogle Scholar
  • 17 Hazneci B, Tan AK, Guncikan MN, Dincer K, Kalyon TA. Comparison of the efficacies of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy: a randomized trial. Mil Med 2006; 171 (07) 653-656
    CrossrefPubMedGoogle Scholar
  • 18 Papavasiliou AS, Rapidi CA, Filiopoulos C, Rizou C, Skouteli HN. Evaluation of a multimodal management of prematurity-related spasticity. Pediatr Neurol 2006; 35 (06) 400-407
    CrossrefPubMedGoogle Scholar
  • 19 Corry IS, Cosgrove AP, Duffy CM, McNeill S, Taylor TC, Graham HK. Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial. J Pediatr Orthop 1998; 18 (03) 304-311
    PubMedGoogle Scholar
  • 20 Koman LA, Brashear A, Rosenfeld S. , et al. Botulinum toxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial. Pediatrics 2001; 108 (05) 1062-1071
    CrossrefPubMedGoogle Scholar
  • 21 Wang Y, Gao B. A dose-response relationship research on botulinum toxin type A local intramuscular injections of lower extremity spasticity in children with cerebral palsy. Childs Nerv Syst 2008; 24 (05) 545-547
    CrossrefPubMedGoogle Scholar
  • 22 Metaxiotis D, Siebel A, Doederlein L. Repeated botulinum toxin A injections in the treatment of spastic equinus foot. Clin Orthop Relat Res 2002; (394) 177-185
    PubMedGoogle Scholar
  • 23 Pidcock FS. Botulinum toxin type A treatment in neurogenetic syndromes. Pediatr Rehabil 2005; 8 (04) 298-302
    CrossrefPubMedGoogle Scholar
  • 24 Kawamura A, Campbell K, Lam-Damji S, Fehlings D. A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity. Dev Med Child Neurol 2007; 49 (05) 331-337
    CrossrefPubMedGoogle Scholar
  • 25 Lowe K, Novak I, Cusick A. Low-dose/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy. Dev Med Child Neurol 2006; 48 (03) 170-175
    CrossrefPubMedGoogle Scholar
  • 26 Russo RN, Crotty M, Miller MD, Murchland S, Flett P, Haan E. Upper-limb botulinum toxin A injection and occupational therapy in children with hemiplegic cerebral palsy identified from a population register: a single-blind, randomized, controlled trial. Pediatrics 2007; 119 (05) e1149-e1158
    CrossrefPubMedGoogle Scholar
  • 27 Wallen M, O'Flaherty SJ, Waugh MC. Functional outcomes of intramuscular botulinum toxin type a and occupational therapy in the upper limbs of children with cerebral palsy: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 28 Carraro E, Trevisi E, Martinuzzi A. Safety profile of incobotulinum toxin A [Xeomin(®)] in gastrocnemious muscles injections in children with cerebral palsy: randomized double-blind clinical trial. Eur J Paediatr Neurol 2016; 20 (04) 532-537
    CrossrefPubMedGoogle Scholar
  • 29 Eek MN, Himmelmann K. No decrease in muscle strength after botulinum neurotoxin-a injection in children with cerebral palsy. Front Hum Neurosci 2016; 10: 506 eCollection 2016
    PubMedGoogle Scholar
  • 30 Goldstein EM. Safety of high-dose botulinum toxin type A therapy for the treatment of pediatric spasticity. J Child Neurol 2006; 21 (03) 189-192
    CrossrefPubMedGoogle Scholar
  • 31 Boulay C, Jacquemier M, Castanier E. , et al. Planovalgus foot deformity in cerebral palsy corrected by botulinum toxin injection in the peroneus longus: clinical and radiological evaluations in young children. Ann Phys Rehabil Med 2015; 58 (06) 316-321
    CrossrefPubMedGoogle Scholar
  • 32 Sutcliffe TL, Gaetz WC, Logan WJ, Cheyne DO, Fehlings DL. Cortical reorganization after modified constraint-induced movement therapy in pediatric hemiplegic cerebral palsy. J Child Neurol 2007; 22 (11) 1281-1287
    CrossrefPubMedGoogle Scholar
  • 33 Yang TF, Fu CP, Kao NT, Chan RC, Chen SJ. Effect of botulinum toxin type A on cerebral palsy with upper limb spasticity. Am J Phys Med Rehabil 2003; 82 (04) 284-289
    PubMedGoogle Scholar
  • 34 Boyd R, Graham HK. Botulinum toxin A in the management of children with cerebral palsy: indication and outcome. Eur J Neurol 1997; 4 (Suppl. 02) S15-S22
    CrossrefPubMedGoogle Scholar
  • 35 Moleaners G, Desloovere K, Eyssen M. , et al. Botulinum toxin type A treatment of cerebral palsy: an integrated approach. Eur J Neurol 1999; 6 (Suppl. 04) S51-S57
    CrossrefPubMedGoogle Scholar
  • 36 Dai AI, Demiryürek AT. Serial casting as an adjunct to botulinum toxin type a treatment in children with cerebral palsy and spastic paraparesis with scissoring of the lower extremities. J Child Neurol 2017; 32 (07) 671-675
    CrossrefPubMedGoogle Scholar
  • 37 Bertoncelli CM, Solla F, Loughenbury PR, Tsirikos AI, Bertoncelli D, Rampal V. Risk factors for developing scoliosis in cerebral palsy: a cross-sectional descriptive study. J Child Neurol 2017; 32 (07) 657-662
    CrossrefPubMedGoogle Scholar
  • 38 Bertoncelli CM, Bertoncelli D, Elbaum L. , et al. Validation of a clinical prediction model for the development of neuromuscular scoliosis: a multinational study. Pediatr Neurol 2018; 79: 14-20
    CrossrefPubMedGoogle Scholar