New Insights Into Botulinum Toxin (BoNT-A) Injections for Children with Severe Cerebral Palsy
Botulinum toxin type A (BoNT-A), often called “Botox,” is used to help manage tight muscles (spasticity) in children with cerebral palsy (CP). For children with severe CP - those classified at Level IV or V on the Gross Motor Function Classification System and represents approximately one-third of all pediatric CP cases - BoNT-A injections can play an important role in ease of care, pain relief, and motor function changes making daily life manageable.
A recent review published in the Journal of Pediatric Neurology by the WFCPC’s Eduardo del Rosario, PhD, FNP-BC and colleague analyzed 25 studies to examine the effects of BoNT-A injections to the lower extremities of pediatric participants with severe cerebral palsy on improving ease of care, pain and motor function. Of these studies, three were randomized controlled trials (RCT), 16 non-randomized studies of interventions involving a botulinum-treated group with prospective data collection. Six studies focused solely on the targeted population while the remainder included participants of a wider range of CP severity. Overall findings:
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Ease of Care was generally reported as improved, and greater at early than later follow up.
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Pain Relief was variable. As such, one RCT on postoperative pain was significantly reduced but not in another RCT. Non-specific pain was signficantly reduced in some cases. Joint specific pain was decreased in only one study.
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Motor Function Changes were the most frequently evaluated in these studies. The reported pre- to post BoNT-A injection motor function improvement was without a comparison group and only a few used standardized assessment tools e.g., Gross Motor Function System (GMFCS).
The paper concludes that the current research data on the effects of BoNT-A injections on the pediatric population with severe CP lacks rigor and is insufficient to conclude BoNT-A injections' effectiveness. Future research will need to focus on this specific group of participants only, use validated assessment tools and narrative data targeting areas of daily life that are meaningful to patients and their caregivers.