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Effects of botulinum toxin type A on upper limb function in children with cerebral palsy: a systematic review

Alexander Reeuwijk1, Petra E M van Schie, Jules G Becher

  • 1Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. a.reeuwijk@vumc.nl

Clinical Rehabilitation
|June 16, 2006
PubMed

Insights

Botulinum toxin type A injections show insufficient evidence for improving upper limb function, spasticity, or range of motion in children with cerebral palsy due to assessment limitations.

Area of Science:

  • Pediatric Neurology
  • Rehabilitation Medicine
  • Movement Disorders

Background:

  • Cerebral palsy (CP) is a common neurodevelopmental disorder affecting movement and posture.
  • Upper limb dysfunction is a significant challenge for children with CP, impacting daily activities.
  • Botulinum toxin type A is used to manage spasticity, but its efficacy for functional improvement in pediatric CP is debated.

Purpose of the Study:

  • To evaluate the effectiveness of botulinum toxin type A injections in improving upper limb function in children with cerebral palsy.
  • To synthesize current evidence on the impact of botulinum toxin type A on spasticity, range of motion, and functional activities in pediatric CP.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (PubMed, CINAHL, EMBASE, PEDRO, Cochrane).
  • Included studies comprised randomized controlled trials (RCTs) and uncontrolled studies.
  • Evidence was synthesized using a best-evidence approach.

Main Results:

  • Three high-quality RCTs and nine methodologically sound uncontrolled studies were included.
  • Limited evidence suggests short-term spasticity reduction in some studies.
  • Inconsistent findings regarding improvements in range of motion and functional upper limb activities were reported across studies.

Conclusions:

  • Current evidence is insufficient to support botulinum toxin type A injections for reducing spasticity or enhancing upper limb function in pediatric cerebral palsy.
  • Lack of robust evidence is attributed to varied treatment goals, inadequate assessment tools, and insufficient statistical power.
  • Further high-quality research with validated outcome measures is needed to clarify the role of botulinum toxin type A in pediatric CP.
Abstract

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