Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Neurosciences, Neurosciences & Neurology, botulinum neurotoxin A, cerebral palsy, equinus, gait, goal attainment, gross motor function, spasticity, GROSS MOTOR FUNCTION, ANKLE-FOOT ORTHOSIS, RANDOMIZED CONTROLLED-TRIAL, LOWER-EXTREMITY SPASTICITY, PLACEBO-CONTROLLED TRIAL, DOUBLE-BLIND, COMPREHENSIVE REHABILITATION, INTRAMUSCULAR INJECTIONS, ADDUCTOR SPASTICITY, MUSCLE ACTIVATIONS, Adolescent, Botulinum Toxins, Cerebral Palsy, Child, Drug Monitoring, Humans, Internationality, Lower Extremity, Neuromuscular Agents, Outcome Assessment, Health Care, Paraparesis, Spastic, Randomized Controlled Trials as Topic, Cerebral Palsy Institute, 1103 Clinical Sciences, 1109 Neurosciences, Neurology & Neurosurgery, 3202 Clinical sciences, 3209 Neurosciences

Abstract:

Botulinum neurotoxin type-A (BoNT-A) has been used in association with other interventions in the management of spasticity in children with cerebral palsy (CP) for almost two decades. This consensus statement is based on an extensive review of the literature by an invited international committee. The use of BoNT-A in the lower limbs of children with spasticity caused by CP is reported using the American Academy of Neurology Classification of Evidence for therapeutic intervention. Randomized clinical trials have been grouped into five areas of management, and the outcomes are presented as treatment recommendations. The assessment of children with CP and evaluation of outcomes following injection of BoNT-A are complex, and therefore, a range of measures and the involvement of a multidisciplinary team is recommended. The committee concludes that injection of BoNT-A in children with CP is generally safe although systemic adverse events may occur, especially in children with more physical limitations (GMFCS V). The recommended dose levels are intermediate between previous consensus statements. The committee further concludes that injection of BoNT-A is effective in the management of lower limb spasticity in children with CP, and when combined with physiotherapy and the use of orthoses, these interventions may improve gait and goal attainment.