Skip to main content Accessibility help
×
Home

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

  • D. Fehlings (a1) (a2), U. Narayanan (a3), J. Andersen (a4), R. Beauchamp (a5), J. W. Gorter (a6), A. Kawamura (a1), G. Kiefer (a7), M. Mason (a8), A. McCormick (a9), R. Mesterman (a6), L. Switzer (a10) and J. Watt (a4)...

Abstract

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

Corresponding author

Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada. Email: dfehlings@hollandbloorview.ca

References

Hide All
1.Jankovic, J, Brin, MF.Therapeutic uses of botulinum toxin. N Engl J Med. 1991;25(324)(17):118694.
2.Delgado, M, Hirtz, D, Aisen, M, et al.Practice parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology and the practice committee of the Child Neurology Society. Neurology. 2010;74(4):33643.
3.Health Canada [Internet]. Ottawa: Information Update; Health Canada reviewing issue of distant toxin spread potentially associated with Botox and Botox Cosmetic; [about 3 screens]. [updated 2008 Feb 20; cited 2011 Aug 8]. Available from: http://www.hc-sc.gc.ca/ahc-asc/media/advisoriesavis/_2008/2008_32-eng.php
4.Fehlings, D, Novak, I, Berweck, S, Hoare, B, Stott, N, Russo, R.Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement. Eur J Neurol. 2010;17:3856.
5.Love, SC, Novak, I, Kentish, M, et al.Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neurol. 2010;17(Suppl 2):937.
6.Heinen, F, Desloovere, K, Schroeder, AS, et al.The updated European consensus 2009 on the use of botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol. 2010;14(1): 4566. Epub Nov 14, 2009.
7.World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization, 2001.
8.Naumann, M, Albanese, A, Heinen, F, Molenaers, G, Relja, M.Safety and efficacy of botulinum type A following long-term use. Eur J Neurol. 2006;13(Suppl 4):3540.
9.Goldstein, FM.Safety of high-dose botulinum toxin type A therapy for the treatment of pediatric spasticity. J Child Neurol. 2006;21:28992.
10.Pascual-Pascual, SI, Pascual-Castroviejo, I.Safety of botulinum toxin type A in children younger than 2 years. Eur J Pediatr Neurol. 2009;13:51115.
11.Albavera-Hernandez, C, Rodriguez, JM, Idrovo, AJ.Safety of botulinum toxin A among children with spascity secondary to cerebral palsy: systematic review of randomized clinical trials. Clin Rehabil. 2009;23:394407.
12.Naidu, K, Smith, K, Sheedy, M, Adair, B, Yu, X, Graham, K.Systemic adverse events following botulinum toxin A therapy in children with cerebral palsy. Dev Med Child Neurol. 2010;52:13944.
13.Kolaski, K, Ajizian, SJ, Passmore, L, Pasutharnchat, N, Koman, LA, Smith, BP.Safety profile of multilevel chemical denervation procedures using phenol or botulinum toxin or both in a pediatric population. Am J Phys Med Rehabil. 2008;87(7):55666.
14.O’Flaherty, SJ, Janakan, V, Morrow, AM, Scheinberg, AN, Waugh, M-C A.Adverse events and health status following botulinum toxin A injections in children with cerebral palsy. Dev Med Child Neurol. 2011;53:12530.
15.Narayanan, UG.Botulinum toxin: does the black box warning justify change in practice? Dev Med Child Neurol. 2011;53:1012.
16.Schroeder, AS, Ertl-Wagner, B, Britsch, S, et al.Muscle biopsy substantiates long-term MRI alterations one year after a single dose of botulinum toxin injected into the lateral gastrocnemius muscle of healthy volunteers. Mov Disord. 2009;24:1494503.
17.Albusaini, A, Crosbie, J, Shepherd, R, Daean, C, Scheinberg, A.No change in muscle passive stiffness following botulinum toxin injection in children with cerebral palsy. Dev Med Child Neurol. 2011;53:5438.
18.Schroeder, AS, Koerte, I, Berweck, S, Ertl-Wagner, Heinen F.How doctors think and treat with botulinum toxin. Letter to the editor. Dev Med Child Neurol. 2010;52:8756.
19.Barrett, RS.What are the long-term consequences of botulinum toxin injections in spastic cerebral palsy? Dev Med Child Neurol. 2011;53:485.
20.Bedard, P, Tardif, L, Ferland, A, et al.A medication reconciliation form and its impact on the medical record in a paediatric hospital. J Eval Clin Pract. 2009;17:2227.
21.Chin, TY, Nattrass, GR, Selber, P, Graham, HK.Accuracy of intramuscular injection of botulinum toxin A in juvenile cerebral palsy: a comparison between needle placement and placement guided by electrical stimulation. J Pediatr Orthop. 2005;25:28691.
22.Yang, EJ, Rha, D-W, Yoo, JK, Park, ES.Accuracy of needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography. Arch Phys Med Rehabil. 2009; 90:7414.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed