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Botulinum toxin injection as an adjunct when planning hand surgery in children with spastic hemiplegia
I Autti-Rämö1, A Larsen, J Peltonen
1Hospital for Children and Adolescents, Department of Neurology, University Central Hospital of Helsinki, Finland.
Insights
Preoperative botulinum toxin A injections help determine the need for hand surgery in children with spastic hemiplegia. This treatment guides surgical decisions by identifying patients unlikely to benefit from surgery.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Spastic hemiplegia often requires interventions to improve hand function in children.
- Botulinum toxin A is used to manage spasticity, but its role in surgical planning needs clarification.
Purpose of the Study:
- To evaluate the utility of botulinum toxin A (BoNT-A) as a tool for planning hand surgery in pediatric spastic hemiplegia.
- To assess if preoperative BoNT-A treatment can predict surgical outcomes and guide treatment decisions.
Main Methods:
- A cohort of eight children with spastic hemiplegia underwent assessment of hand function.
- Quantitative and qualitative functional assessments were performed before and after botulinum toxin A treatment.
- Treatment outcomes were analyzed to inform surgical planning.
Main Results:
- Preoperative botulinum toxin A treatment supported surgical intervention in four children.
- Serial botulinum toxin A treatment was deemed appropriate for three children.
- One child did not gain additional information from the preoperative botulinum toxin A treatment.
Conclusions:
- Preoperative botulinum toxin A treatment is valuable in most children with spastic hemiplegia considered for hand surgery.
- It helps identify patients who may not benefit from surgery or where benefits do not outweigh risks and rehabilitation burden.
Abstract:
The usefulness of botulinum toxin A treatment when planning hand surgery in eight children with spastic hemiplegia was evaluated. The hand function of the children was assessed before and after treatment using a test battery consisting of quantitative and qualitative functional assessment. The results of preoperative botulinum treatment supported surgical intervention in four children and serial botulinum treatment in three children. In one child, the preoperative botulinum treatment provided no additional information. We conclude that preoperative botulinum A treatment in most children with spastic hemiplegia, for whom hand surgery is being considered, identifies the patients who would not benefit from the planned surgery or for whom the functional benefit would probably not outweigh the burden of surgical procedure and postoperative rehabilitation.