Low-dose botulinum toxin for the treatment of spastic children with cerebral palsy

Abstract

The treatment of children with cerebral palsy (CP) with Botulinum toxin A (BoNT-A) injections is well established, safe and effective. However, a standardized injection strategy is still missing and the used dosage has escalated over the years. The aim was to analyze the efficacy and safety of a lower dose of BoNT-A injections into lower limb in children with CP. We analyzed retrospectively BoNT-A injections for 63 children (25 girls and 38 boys) with spastic CP. Children received 1-7 repeated injections and adapted physiotherapy. Children were classified according to the GMFCS. Treatment results were evaluated with the modified Ashworth scale. Side effects, total dose and dose per body weight were analyzed. Multilevel BoNT-A injections were indicated for 30 patients with spastic forms of CP, and in most of cases, the total dosage was 103.1 ± 20.8 U Allergan for Botox ® and 473 ± 105.9 U Speywood for Dysport ® . Doses for each muscle in U/kg were 1.5 ± 0.5 U Allergan for Botox ® and 3 ± 0.7 U Speywood for Dysport ® . The total doses of BoNT-A and the intervals between the repeated injections were stable for each patient. Side effects reported, out of which 10, were generalized and/or focal distant. Average Modified Ashworth scale decreased 1 point in each session. These effects were retained at 3.5 ± 1.3 months. The lower dose ranges suggested for CP are effective and safe for the reduction of spasticity in lower extremities in one treatment session.