Botulinum Toxin: Techniques Within Pediatric Physiatry

Area of Science:

• Pediatric Rehabilitation Medicine
• Neuromuscular Disorders
• Medical Technology

Background:

• Intramuscular botulinum toxin injections are a primary treatment for focal spasticity in children, especially those with cerebral palsy.
• Current pediatric practices for these injections lack standardized techniques, leading to variability among providers.

Purpose of the Study:

• To delineate the current techniques employed by pediatric physiatrists for administering botulinum toxin injections.
• To identify variations in practice regarding drug formulation, dosage, localization, and adjunctive measures like sedation.

Main Methods:

• A cross-sectional survey was conducted using RedCap Software among pediatric physiatrists in the United States.
• Data from 307 participants were analyzed, focusing on their approaches to botulinum toxin injections, including drug choice, dosing, localization, and sedation/distraction methods.

Main Results:

• OnabotulinumtoxinA is the predominant formulation used. Median doses were 15 units/kg (per series) and 500 units (maximum total).
• Sixty-five percent of physiatrists utilize sedation, with general anesthesia being most common (38.9%), followed by awake anxiolysis (26.2%).
• Injection sites varied, with "multiple sites spread throughout the muscle" being most frequent (67.9%). Guidance methods differed for large (anatomic 75.6%, EMG 50.8%) versus small muscles (EMG 73.6%, anatomic 49.2%).

Conclusions:

• Significant variability exists in the techniques used for botulinum toxin injections by pediatric physiatrists.
• The findings underscore a need for developing standardized protocols to optimize treatment for pediatric spasticity.