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Botulinum Toxin-A use in Paediatric Hypertonia: Canadian Practice Patterns

Published online by Cambridge University Press:  02 December 2014

D. Fehlings ,
U. Narayanan ,
J. Andersen ,
R. Beauchamp ,
J. W. Gorter ,
A. Kawamura ,
G. Kiefer ,
M. Mason ,
A. McCormick  and
R. Mesterman
...Show all authors
D. Fehlings*
Affiliation:
Holland Bloorview Kids Rehabilitation Hospital Department of Paediatrics, University of Toronto, Toronto
U. Narayanan
Affiliation:
The Hospital for Sick Children
J. Andersen
Affiliation:
Glenrose Rehabilitation Hospital, Edmonton
R. Beauchamp
Affiliation:
BC Children's Hospital, Vancouver, BC, Canada
J. W. Gorter
Affiliation:
HHS McMaster University, Hamilton
A. Kawamura
Affiliation:
Holland Bloorview Kids Rehabilitation Hospital
G. Kiefer
Affiliation:
Alberta Children's Hospital, Calgary, Alberta
M. Mason
Affiliation:
Oshawa Clinic, Oshawa
A. McCormick
Affiliation:
Children's Hospital of Eastern Ontario, Ottawa, Ontario
R. Mesterman
Affiliation:
HHS McMaster University, Hamilton
L. Switzer
Affiliation:
Bloorview Research Institute
J. Watt
Affiliation:
Glenrose Rehabilitation Hospital, Edmonton
*
Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada. Email: dfehlings@hollandbloorview.ca
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Abstract

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Background:

This study aims to assess current practices of Canadian physicians providing botulinum toxin-A (BoNT-A) treatments for children with hypertonia and to contrast these with international “best practice” recommendations, in order to identify practice variability and opportunities for knowledge translation.

Methods:

Thirteen Canadian physicians assembled to develop and analyze results of a cross-sectional electronic survey, sent to 50 physicians across Canada.

Results:

Seventy-eight percent (39/50) of physicians completed the survey. The most frequently identified assessment tools were Gross Motor Function Classification System, Modified Tardieu Scale and neurological examination. Goal-setting tools were infrequently utilized. Common indications for BoNT-A injections and the muscles injected were identified. Significant variability was identified in using BoNT-A for hip displacement associated with hypertonia. The most frequent adverse event reported was localized weakness; 54% reporting this “occasionally“ and 15% “frequently”. Generalized weakness, fatigue, ptosis, diplopia, dysphagia, aspiration, respiratory distress, dysphonia and urinary incontinence were reported rarely or never. For dosage, 52% identified 16 Units/kg body weight of Botox® as maximum. A majority (64%) reported a maximum 400 Units for injection at one time. For localization, electrical stimulation and ultrasound were used infrequently (38% and 19% respectively). Distraction was the most frequently used pain-management technique (64%).

Conclusions:

Canadian physicians generally adhere to international best practices when using BoNT-A to treat paediatric hypertonia. Two knowledge-translation opportunities were identified: use of individualized goal setting prior to BoNT-A and enhancing localization techniques. Physicians reported a good safety profile of BoNT-A in children.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 4 , July 2012 , pp. 508 - 515
Copyright
Copyright © The Canadian Journal of Neurological 2012

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