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Related Experiment Video

Updated: Feb 8, 2026

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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Botulinum Toxin: Techniques Within Pediatric Physiatry.

Andrea Paulson1, Christina K Zigler2, Amy Houtrow2

  • 1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267; Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

PM & R : the Journal of Injury, Function, and Rehabilitation
|July 3, 2018
PubMed
Summary
This summary is machine-generated.

Pediatric physiatrists show significant variability in botulinum toxin injection techniques for treating pediatric spasticity. This study highlights diverse practices in dosing, sedation, and localization methods for cerebral palsy patients.

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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.