Yonsei Med J.  2006 Oct;47(5):589-603. 10.3349/ymj.2006.47.5.589.

Botulinum Toxin Type A Injection for Management of Upper Limb Spasticity in Children with Cerebral Palsy: a Literature Review

• Park ES
• Rha DW

• KMID: 1381240
• DOI: http://doi.org/10.3349/ymj.2006.47.5.589

Abstract

The aim of this article was to present a review of the research literature on the outcome of botulinum toxin type A (BTX-A) injection for management of upper limb spasticity in children with cerebral palsy (CP). We searched the electronic databases of MEDLINE, CINAHL and PUBMED for all published studies with full-length English text available. For each study, the quality of the methods and the strength of evidence were assessed by 2 independent reviewers based on the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines. Four studies of level I, 8 studies of level IV and 4 studies of level V were identified. Due to the limited number of studies with high quality evidence and inconsistent results among studies, we were unable to support or refute the usefulness of BTX-A injection for management of upper limb spasticity in children with CP. Moreover, we identified several variables that may affect the outcome of injection, such as timing of age, dosage, dilution volumes, localization techniques of target muscles and participant characteristics. In summary, we have presented a review the literature and a discussion of the considerable uncertainty and variation associated with the clinical use of BTX-A injection for management of upper limb spasticity in children with CP.

Keyword

Cerebral palsy; botulinum toxin type A; spasticity; upper limb

MeSH Terms

Upper Extremity
Range of Motion, Articular/drug effects
Neuromuscular Agents/administration & dosage/*therapeutic use
Muscle Spasticity/drug therapy
Injections
Infant
Humans
Child, Preschool
Child
Cerebral Palsy/*drug therapy
Botulinum Toxin Type A/administration & dosage/*therapeutic use
Age Factors
Adult
Adolescent

Reference

1. Gormley ME, Gaebler-Spira D, Delgado MR. Use of botulinum toxin type A in pediatric patients with cerebral palsy: a three-center retrospective chart review. J Child Neurol. 2001. 16:113–118.

2. Russman BS, Tilton A, Gormley ME Jr. Cerebral palsy: a rational approach to a treatment protocol, and the role of botulinum toxin in treatment. Muscle Nerve Suppl. 1997. 6:S181–S193.

3. Corry IS. Use of a motion analysis laboratory in assessing the effects of botulinum toxin in a cerebral palsy. 1995. Belfast (North Ireland): The Queens University;Thesis for doctor of medicine in the faculty of medicine.

4. Cosgrove AP, Graham HK. Botulinum toxin A prevents the development of contractures in the hereditary spastic mouse. Dev Med Child Neurol. 1994. 36:379–385.

5. Dunne JW, Heye N, Dunne SL. Treatment of chronic limb spasticity with botulinum toxin A. J Neurol Neurosurg Psychiatry. 1995. 58:232–235.

6. Lance JW. Feldman RG, Young RR, Koella WP, editors. Pathophysiology of spasticity and clinical experience of baclofen. Spasticity: disordered motor control. 1980. Chicago: Year Book Medical Publishers;185–203.

7. Ziv I, Blackburn N, Rang M, Koreska J. Muscle growth in normal and spastic mice. Dev Med Child Neurol. 1984. 26:94–99.

8. Mohamed KA, Moore AP, Rosenbloom L. Adverse events following repeated injections with botulinum toxin A in children with spasticity. Dev Med Child Neurol. 2001. 43:791.

9. Aoki KR, Guyer B. Botulinum toxin type A and other botulinum toxin serotypes: a comparative review of biochemical and pharmacological actions. Eur J Neurol. 2001. 8:Suppl 5. 21–29.

10. Buttler C. American Academy of Cerebral Palsy and Developmental Medicine methodology for developing evidence tables and reviewing treatment outcomes research. Available from: URL: www.aacpdm.org/resources/But-guide.pdf.

11. Fehlings D, Rang M, Glazier J, Steele C. An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy. J Pediatr. 2000. 137:331–337.

12. Friedman A, Diamond M, Johnston MV, Daffner C. Effects of botulinum toxin A on upper limb spasticity in children with cerebral palsy. Am J Phys Med Rehabil. 2000. 79:53–59. quiz 75-6.

13. Gooch JL, Sandell TV. Botulinum toxin for spasticity and athetosis in children with cerebral palsy. Arch Phys Med Rehabil. 1996. 77:508–511.

14. Wallen MA, O'Flaherty SJ, Waugh MC. Functional outcomes of intramuscular botulinum toxin type A in the upper limbs of children with cerebral palsy: a phase II trial. Arch Phys Med Rehabil. 2004. 85:192–200.

15. Wong V, Ng A, Sit P. Open-label study of botulinum toxin for upper limb spasticity in cerebral palsy. J Child Neurol. 2002. 17:138–142.

16. Autti-Ramo I, Larsen A, Taimo A, von Wendt L. Management of the upper limb with botulinum toxin type A in children with spastic type cerebral palsy and acquired brain injury: clinical implications. Eur J Neurol. 2001. 8:Suppl 5. 136–144.

17. Lowe K, Novak I, Cusick A. Low-dose/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2006. 48:170–175.

18. Fehlings D, Rang M, Glazier J, Steele C. Botulinum toxin type A injections in the spastic upper extremity of children with hemiplegia: child characteristics that predict a positive outcome. Eur J Neurol. 2001. 8:Suppl 5. 145–149.

19. Hurvitz EA, Conti GE, Brown SH. Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection. Arch Phys Med Rehabil. 2003. 84:444–454.

20. Hurvitz EA, Conti GE, Flansburg EL, Brown SH. Motor control testing of upper limb function after botulinum toxin injection: a case study. Arch Phys Med Rehabil. 2000. 81:1408–1415.

21. Yang TF, Fu CP, Kao NT, Chan RC, Chen SJ. Effect of botulinum toxin type A on cerebral palsy with upper limb spasticity. Am J Phys Med Rehabil. 2003. 82:284–289.

22. Corry IS, Cosgrove AP, Walsh EG, McClean D, Graham HK. Botulinum toxin A in the hemiplegic upper limb: a double-blind trial. Dev Med Child Neurol. 1997. 39:185–193.

23. Speth LA, Leffers P, Janssen-Potten YJ, Vles JS. Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy. Dev Med Child Neurol. 2005. 47:468–473.

24. Mall V, Heinen F, Linder M, Philipsen A, Korinthenberg R. Treatment of cerebral palsy with botulinum toxin A: functional benefit and reduction of disability. Three case reports. Pediatr Rehabil. 1997. 1:235–237.

25. Graham HK, Aoki KR, Autti-Ramo I, Boyd RN, Delgado MR, Gaebler-Spira DJ, et al. Recommendations for the use of botulinum toxin type A in the management of cerebral palsy. Gait Posture. 2000. 11:67–79.

26. Kinnett D. Botulinum toxin A injections in children: technique and dosing issues. Am J Phys Med Rehabil. 2004. 83:S59–S64.

27. Hsu TS, Dover JS, Arndt KA. Effect of volume and concentration on the diffusion of botulinum exotoxin A. Arch Dermatol. 2004. 140:1351–1354.

28. Arens LJ, Leary PM, Goldschmidt RB. Experience with botulinum toxin in the treatment of cerebral palsy. S Afr Med J. 1997. 87:1001–1003.

29. Denislic M, Meh D. Botulinum toxin in the treatment of cerebral palsy. Neuropediatrics. 1995. 26:249–252.

30. Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964. 192:540–542.

31. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987. 67:206–207.

32. Lakie M, Walsh EG, Wright GW. Assessment of human hemiplegic spasticity by a resonant frequency method. Clin Biomech. 1988. 3:173–178.

33. Tardieu G, Shentoub S, Delarue R. Research on a technic for measurement of spasticity. Rev Neurol (Paris). 1954. 91:143–144.

34. Norkin CC, White DJ. Measurement of joint motion: A guide to goniometry. 2003. 3rd ed. Philadelphia: F.A. Davis Company.

35. Wall SA, Chait LA, Temlett JA, Perkins B, Hillen G, Becker P. Botulinum A chemodenervation: a new modality in cerebral palsied hands. Br J Plast Surg. 1993. 46:703–706.

36. DeMatteo C, Law M, Russell D, Pollock N, Rosenbaum P, Walter S. The reliability and validity of the quality of upper extremity skills test. Pediatric Phys Occup Ther. 1993. 13:1–18.

37. Randall M, Carlin JB, Chondros P, Reddihough D. Reliability of the Melbourne assessment of unilateral upper limb function. Dev Med Child Neurol. 2001. 43:761–767.

38. Boyd RN, Graham HK. Botulinum toxin A in the management of children with cerebral palsy: indications and outcome. Eur J Neurol. 1997. 4:S15–S22.

39. Boyd RN, Hays RM. Current evidence for the use of botulinum toxin type A in the management of children with cerebral palsy: a systematic review. Eur J Neurol. 2001. 8:Suppl 5. 1–20.

40. Chin TY, Nattrass GR, Selber P, Graham HK. Accuracy of intramuscular injection of botulinum toxin A in juvenile cerebral palsy: a comparison between manual needle placement and placement guided by electrical stimulation. J Pediatr Orthop. 2005. 25:286–291.

41. Childers MK. Targeting the neuromuscular junction in skeletal muscles. Am J Phys Med Rehabil. 2004. 83:S38–S44.

42. Berweck S, Schroeder AS, Fietzek UM, Heinen F. Sonography-guided injection of botulinum toxin in children with cerebral palsy. Lancet. 2004. 363:249–250.

43. Kim HS, Hwang JH, Jeong ST, Lee YT, Lee PK, Suh YL, et al. Effect of muscle activity and botulinum toxin dilution volume on muscle paralysis. Dev Med Child Neurol. 2003. 45:200–206.

44. Shaari CM, Sanders I. Quantifying how location and dose of botulinum toxin injections affect muscle paralysis. Muscle Nerve. 1993. 16:964–969.

45. Francisco GE. Botulinum toxin: dosing and dilution. Am J Phys Med Rehabil. 2004. 83:S30–S37.