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BOTULINUM TOXIN TYPE A DOSING FOR THE MANAGEMENT IN SPASTIC CEREBRAL PALSY
Emily McGhee1 Matthew McLaughlin2
1UMKC
INTRODUCTION
• Spastic cerebral palsy (SCP) has been treated with
oral medications with varied levels of adverse
events and efficacy.2
• Botulinum Toxin Type A (BoNT-A) – Injected
locally for more focalized effects. Dosing in the
pediatric population has not been described.
• BoNT-A acts by inhibiting acetylcholine release at
the neuromuscular junction.
• Gross Motor Functional Classification System
(GMFCS) – Used to determine level of functional
ambulation potential (figure 1).
• Adverse events, such as hospitalizations, after
injections with BoNT-A have not been previously
reported in pediatrics.
School of Medicine 2Children’s Mercy Hospital. Kansas City, MO.
METHODS
• Chart Review 500 Children with SCP.
• Reviewed most recent rehabilitation note: age,
weight in Kg, location and type of cerebral palsy,
GMFCS score, medications and dosing, and
hospitalizations 6 months after BoNT-A.
• Analysis of BoNT-A dose per kilogram compared
across GMFCS scores.
• One way ANOVA was used to used to determine
differences between GMFCS levels.
RESULTS
• GMFCS 1 or 2 received less BoNT-A per kilogram
compared to groups 3-5. (p<0.0005) (figure 2).
• 23/256 patients who received BoNT-A inpatient
medical services 6 months after receiving
injection compared to 16/236 (figure 3).
SUMMARY
• Fewer BoNT-A units were used in patients who
were more functionally ambulatory.
• More unexpected admissions occurred within 6
months after BoNT-A injections .
• More unexpected admissions were seen in higher
GMFCS scores.
CONCLUSION
• Higher GMFCS scores (3-5) require higher doses
of Botox to treat spasticity compared to a lower
GMFCS score (1-2).
• Lower GMFCS Scores (1-2) had fewer unplanned
admissions to the hospital.
• Future studies to evaluate efficacy and dosing
differences across GMFCS categories would be
helpful.
Figure 3. Comparison of planned vs. unplanned admissions in
patients with BoNT-A injections and without BoNT-A injections
CREDITS/REFERENCES
•
Figure 1. GMFCS Scale. (1 – ambulating independently and
5 –for ambulation) totally dependent.1
Figure 2. Comparison of BoNT-A units per kilogram based on GMFCS
category.
•
1. Figure 1: GMFCS Scale. https://kumc-ptrsebp.wikispaces.com/Interventions+for+the+Treatment+of+Spasticity+in+Children+with+Cereb
ral+Palsy. Accessed February 9, 2016.
2. Matthews D. Management of spasticity in children with cerebral palsy. Acta Orthop
Traumatol Turc. 2009; 43(2):81-86