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Adjunct therapies to improve outcomes after botulinum toxin injection in children: A systematic review

L Mathevon1, I Bonan2, J-L Barnais3

  • 1Department of Physical and Rehabilitation Medicine, CHU de Grenoble, 38000 Grenoble, France.

Annals of Physical and Rehabilitation Medicine
|August 1, 2018
PubMed

Insights

Adjunct therapies like casting improve spasticity and motion in children after botulinum toxin (BTX) injections. Resistance training also shows promise for muscle function, but more research is needed on other methods.

Area of Science:

  • Pediatrics
  • Neurology
  • Rehabilitation Medicine

Background:

  • Botulinum toxin (BTX) injections alone are insufficient for treating spasticity in children, particularly those with cerebral palsy.
  • Adjunct therapies are increasingly used to enhance outcomes beyond BTX monotherapy.

Purpose of the Study:

  • To systematically review the effectiveness of various adjunct therapies used in conjunction with BTX injections for pediatric spasticity.

Main Methods:

  • A systematic review of Medline, Cochrane, and Embase databases (1980-2018) for parallel-group trials (RCTs and non-RCTs).
  • Data extraction and risk of bias assessment using PEDro and Downs and Black scales.
  • Inclusion of studies assessing adjunct therapies following BTX injection for spasticity in children.

Main Results:

  • Twenty articles with 662 participants were included; RCTs were of good quality, non-RCTs of poor to moderate quality.
  • Casting/posture combined with BTX improved range of motion and reduced spasticity compared to BTX alone (9 studies).
  • Resistance training enhanced muscle quality and performance without increasing spasticity; rehabilitation programs showed encouraging results for activities.

Conclusions:

  • Lower-limb casting with BTX has high evidence for improving spasticity and motion, but long-term efficacy and optimal timing require further study.
  • Electrical stimulation data are inconclusive; resistance training is a promising adjunct to prevent strength loss.
  • Rehabilitation programs require further evaluation as adjunct therapies post-BTX injection.
Abstract

Keywords:
Botulinum toxinCastingCerebral palsyRehabilitation programmeSpasticity

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