Why should non-ambulatory children get botox for cerebral palsy? It improves care.

I have performed botox injections as a rehabilitation technique since 2000. As the only neurologist in Houston who is a member of the AACPDM, I am often asked why I offer this procedure?

In non-ambulant children it makes a significant difference in quality of life.  

I lament the fear-mongering about adverse effects. While these events can happen, they are very rare. Almost all families return for repeat procedures. I see families who drive from Louisiana, Dallas and San Antonio who come every 3-4 months. 

Here is another article demonstrating efficacy without major adverse effects!

Dr. R

J Pediatr. 2014 Mar 12. pii: S0022-3476(14)00078-X. doi: 10.1016/j.jpeds.2014.01.050. [Epub ahead of print]

Botulinum Toxin A for Nonambulatory Children with Cerebral Palsy: 

A Double Blind Randomized Controlled Trial.

Copeland L1, Edwards P2, Thorley M2, Donaghey S2, Gascoigne-Pees L2, Kentish M2, Cert G2, Lindsley J2, McLennan K2, Sakzewski L3, Boyd RN3.

Author information

Abstract

OBJECTIVES:

To examine the efficacy and safety of intramuscular botulinum toxin A (BoNT-A) to reduce spasticity and improve comfort and ease of care in nonambulant children with cerebral palsy (CP).

STUDY DESIGN:

Nonambulant children with CP (n = 41; Gross Motor Function Classification System level IV = 3, level V = 38; mean age 7.1 years, range 2.3-16 years, 66% male) were randomly allocated to receive either intramuscular BoNT-A injections (n = 23) or sham procedure (n = 18) combined with therapy. The analysis used generalized estimating equations with primary outcome the Canadian Occupational Performance Measure (COPM) at 4 weeks postintervention and retention of effects at 16 weeks. Adverse events (AE) were collected at 2, 4, and 16 weeks by a physician masked to group allocation.

RESULTS:

There were significant between group differences favoring the BoNT-A-treated group on COPM performance at 4 weeks (estimated mean difference 2.2, 95% CI 0.8, 3.5; P = .002) and for COPM satisfaction (estimated mean difference 2.2, 95% CI 0.5, 3.9; P = .01). These effects were retained at 16 weeks for COPM satisfaction (estimated mean difference 1.8, 95% CI 0.1, 3.5; P = .04). There were more mild AE at 4 weeks for the BoNT-A group (P = .002), however, there were no significant between-group differences in the reporting of moderate and serious AE.

CONCLUSIONS:

In a double-blind randomized sham-controlled trial, intramuscular BoNT-A and therapy were effective for improving ease of care and comfort for nonambulant children with CP. There was no increase in moderate and severe AE in the children who had BoNT-A injections compared with the sham group.

Crown Copyright © 2014. Published by Mosby, Inc. All rights reserved.