Abstract
Botulinum toxin type A (BTXA) has been used for over 25 years in the management of pediatric lower and upper limb hypertonia, with the first reports in 1993. The most common indication is the injection of the triceps surae muscle for the correction of spastic equinus gait in children with cerebral palsy. The upper limb injection goals include improvements in function, better positioning of the arm, and facilitating the ease of care. Neurotoxin type A is the most widely used serotype in the pediatric population. After being injected into muscle, the release of acetylcholine at cholinergic nerve endings is blocked, and a temporary denervation and atrophy ensues. Targeting the correct muscle close to the neuromuscular junctions is considered essential and localization techniques have developed over time. However, each technique has its own limitations. The role of BTXA is flexible, but limited by the temporary mode of action as a focal spasticity treatment and the restrictions on the total dose deliverable per visit. As a mode of treatment, repeated BTXA injections are needed. This literature reviewed BTXA injection techniques, doses and dilutions, the recovery of muscles and the impact of repeated injections, with a focus on the pediatric population. Suggestions for future studies are also discussed.
Highlights
Botulinum toxin type A (BTXA) has been used in the treatment of pediatric lower and upper limb hypertonia for over 25 years, mostly in cerebral palsy (CP)
BTXA is used for facilitating milestones, improving function and posture, easing pain or care, and as a means of “buying time” until the child is sufficiently mature for more definitive procedures [1,3]
Few deaths have been reported in the literature, and caution is recommended in children with pre-existing bulbar symptoms, gastro-esophageal reflux, or frequent chest infections, as these conditions expose patients to aspiration pneumonia [3]
Summary
Botulinum toxin type A (BTXA) has been used in the treatment of pediatric lower and upper limb hypertonia for over 25 years, mostly in cerebral palsy (CP). Spastic equinus management with BTXA is regarded as useful from age two to six years but in most children over the age of six years requires muscle-tendon lengthening [4]. The toxin is produced by the anaerobic spore-forming bacteria Clostridium botulinum of which seven immunologically distinct serotypes designated with alphabetical letters from A to G have been identified. As more information on the sites of NMJs in upper and lower extremity muscles has become available, the exact targeting of injections is possible. The focus was on pediatric studies with patients under the age of 18 but relevant animal and adult studies were included as well
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
