Best clinical practice in botulinum toxin treatment for children with cerebral palsy

Area of Science:

• Pediatric Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• Botulinum toxin A (BoNT-A) is a widely used therapy for managing spasticity in children with cerebral palsy (CP).
• Established treatment protocols have evolved since 1993, necessitating updates in clinical practice.
• Recent observations highlight potential risks associated with BoNT-A in children with higher Gross Motor Function Classification System (GMFCS) levels (IV and V).

Purpose of the Study:

• To summarize the current state-of-the-art in BoNT-A treatment for pediatric cerebral palsy.
• To provide expert-driven recommendations for optimizing BoNT-A therapy in this population.
• To emphasize the importance of individualized, multimodal management strategies.

Main Methods:

• Literature review of existing BoNT-A treatment guidelines and research.
• Consensus-building based on expert opinions from an international pediatric orthopedic user group.
• Analysis of modifications in clinical decision-making, indications, injection techniques, and evaluation methods.

Main Results:

• BoNT-A is a crucial component of multimodal management for improving motor development and function in CP.
• Individualized assessment, goal setting (long-term and per cycle), and targeted muscle selection are essential for effective treatment.
• A focused approach is necessary to enhance function, promote motor development, and prevent adverse outcomes like contractures.

Conclusions:

• BoNT-A treatment for children with CP requires an integrated, individualized approach tailored to specific needs and motor milestones.
• Careful consideration of target muscles and treatment timelines, from infancy to adulthood, is vital for maximizing benefits and mitigating risks.
• Experienced injectors and appropriate patient selection are key to safe and effective BoNT-A therapy, particularly for children with varying GMFCS levels.