Botulinum toxin-A use in paediatric hypertonia: Canadian practice patterns

Area of Science:

• Pediatric Neurology
• Rehabilitation Medicine
• Pharmacology

Background:

• Hypertonia in children significantly impacts motor function and quality of life.
• Botulinum toxin-A (BoNT-A) is a key therapeutic agent for managing pediatric hypertonia.
• Assessing current clinical practices is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate Canadian physicians' current practices in administering BoNT-A for pediatric hypertonia.
• To compare these practices against established international best practice recommendations.
• To identify variations in clinical approaches and opportunities for knowledge translation.

Main Methods:

• A cross-sectional electronic survey was distributed to 50 Canadian physicians.
• Thirteen physicians participated in the survey development and analysis.
• Survey responses from 78% of physicians provided data on assessment tools, indications, adverse events, dosage, localization, and pain management.

Main Results:

• Common assessment tools included Gross Motor Function Classification System and Modified Tardieu Scale; goal-setting tools were rarely used.
• Significant variability existed in BoNT-A use for hip displacement; localized weakness was the most common adverse event.
• Electrical stimulation and ultrasound for localization were infrequently employed, while distraction was the primary pain management technique.

Conclusions:

• Canadian physicians' use of BoNT-A for pediatric hypertonia generally aligns with international best practices.
• Opportunities for knowledge translation include promoting individualized goal setting and improving localization techniques.
• BoNT-A demonstrates a favorable safety profile in pediatric patients.