Three-year outcomes of repeated botulinum neurotoxin in Children

This study aimed to evaluate the effectiveness of repeated botulinum neurotoxin A (BoNT-A) injections on gross motor function over 3 years in ambulant children with spastic cerebral palsy (CP). Results indicated that repeated BoNT-A injections over 3 years were not associated with improvements in gross motor function or passive ankle dorsiflexion range in young children with spastic CP functioning in GMFCS levels I to III compared to a comparison group not receiving BoNT-A.

CanChild Co-Authors: Darcy Fehlings, Peter Rosenbaum, F. Virginia Wright

Botulinum toxin type A (BoNT-A) is often used in children with cerebral palsy (CP) to reduce spasticity. It is unknown whether repeated BoNT-A injections improve gross motor function in young children (under the age of 6 years) with spastic CP who are walking. The main goal of this study was to assess if repeated BoNT-A improved gross motor function compared to children who did not receive BoNT-A over a 3-year period.

In this study, we followed a group of 65 children, 2 to 6 years old with spastic CP who were walking (either by themselves or with a walker), who received repeated BoNT-A injections over a 3-year period. We measured gross motor function, range of motion (flexibility), and multiple measures of activity and participation, including a count of daily steps, and compared these outcomes to a similar group of 59 children who did not receive BoNT-A.

Overall, our study found no difference in gross motor function between individuals receiving and not receiving BoNT-A over the 3-year time period. While there was no significant difference between groups in total daily steps, the group receiving BoNT-A took an average of 622 more steps per day than those not receiving BoNT-A, which approaches the difference that is expected to be meaningful (627 steps). The difference between the groups in ankle range of motion over time was not clinically meaningful.

In summary, we did not find better gains in gross motor function or ankle flexibility in young children with spastic CP receiving repeated BoNT-A injections versus those not receiving BoNT-A.

Here is the full CanChild Study