A French observational study of botulinum toxin use in the management of children with cerebral palsy: BOTULOSCOPE

• Published in: European journal of paediatric neurology Vol. 15; no. 5; pp. 439 - 448
• Main Authors: Chaléat-Valayer, Emmanuelle, Parratte, Bernard, Colin, Cyrille, Denis, Angélique, Oudin, Séverine, Bérard, C, Bernard, J.C, Bourg, V, Deleplanque, B, Dulieu, I, Evrard, P, Filipetti, P, Flurin, V, Gallien, P, Héron-Long, B, Hodgkinson, I, Husson, I, Jaisson-Hot, I, Maupas, E, Meurin, F, Monnier, G, Pérennou, D, Pialoux, B, Quentin, V, Moreau, M. Simonetta, Schneider, M, Yelnik, Alain, Marque, Philippe
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2011; Elsevier
• Subjects: Adolescent; Botulinum toxin; Botulinum Toxins, Type A; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - adverse effects; Cerebral Palsy; Cerebral Palsy - complications; Cerebral Palsy - drug therapy; Cerebral Palsy - physiopathology; Child; Child, Preschool; Cognitive Sciences; Female; Follow-Up Studies; France; Humans; Injections, Intramuscular; Injections, Intramuscular - methods; Life Sciences; Male; Muscle Spasticity; Muscle Spasticity - drug therapy; Muscle Spasticity - etiology; Muscle Spasticity - physiopathology; Neurology; Neuromuscular Agents; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - adverse effects; Neurons and Cognition; Pediatrics; Prospective Studies; routine practice; France; Cerebral Palsy; routine practice; Botulinum toxin
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2010.04.006

Abstract Background Dystonia and spasticity are common symptoms in children with Cerebral Palsy (CP), whose management is a challenge to overcome in order to enable the harmonized development of motor function during growth. Aim To describe botulinum toxin A (BTX-A) use and efficacy as a treatment of focal spasticity in CP children in France. Methods This prospective observational study included 282 CP children mostly administered according to French standards with BTX-A in lower limbs. Realistic therapeutic objectives were set with parents and children together before treatment initiation and assessed using the Visual Analogue Scale (VAS). Child management was recorded and the efficacy of injections was assessed during a 12-month follow-up period by physicians (Modified Ashworth Scale, joint range of motion, Physician Rating Scale, Gillette Functional Assessment Questionnaire and Gross Motor Function Measure-66) and by patients/parents (Visual Analogue Scale). Results BTX-A treatment was administered in different muscle localizations at once and at doses higher than those recommended by the French Health Authorities. Children were treated in parallel by physiotherapy, casts and ortheses. Injections reduced spasticity and improved joint range of motion, gait pattern and movement capacity. Pain was reduced after injections. BTX-A administration was safe: no botulism-like case was reported. The log of injected children who were not included in the study suggested that a large population could benefit from BTX-A management. Conclusions We showed here the major input of BTX-A injections in the management of spasticity in CP children. The results are in favor of the use of BTX-A as conservative safe and efficient treatment of spasticity in children, which enables functional improvement as well as pain relief.