Botulinum toxin A injections in children: technique and dosing issues

Information is presented on the current state of administering botulinum toxin A injections in the pediatric population based on review of scientific publications cited in MEDLINE and PubMed that involved the use of botulinum toxin A in patients under the age of 19. Studies were selected if they contained nearly complete information on botulinum toxin dosing and injection technique within the article. In addition, consensus articles from pediatric task forces were selected for review. Information regarding botulinum toxin A dosing and injection technique was gathered from the material and method sections of the selected studies or from tables in consensus articles. Information was collected in regard to the total amount of botulinum toxin used, commercial brand of botulinum toxin used, dilution of the toxin, volume of toxin preparation, needle size, localization technique, adverse reactions, and whether sedation was used. There is currently a range of dosing and injections techniques in the literature when using botulinum toxin A in children. Body weight, muscle size, location of muscle, and degree of spasticity are all considered to determine total amount of botulinum toxin injected. Concentration and volume of the diluted toxin can affect the amount of spread of the toxin after injection. Injection techniques also vary and are not well reported. Use of electromyographic, electrical stimulation, or ultrasound guidance is employed in children for difficult to locate individual muscle groups. Use of sedation also varies between medical centers.