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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