Systemic adverse events after botulinum neurotoxin A injections in children with cerebral palsy
Simon P Paget1, Caitlyn M Swinney2, Karen L O Burton1
1The Children's Hospital at Westmead, Westmead, NSW, Australia.
Insights
Systemic adverse events after botulinum neurotoxin A (BoNT-A) injections in children with cerebral palsy (CP) occurred in 3.6% of cases. A history of dysphagia and/or aspiration pneumonia significantly increased the risk of these events.
Area of Science:
- Neurology
- Pediatric Medicine
- Pharmacology
Background:
- Botulinum neurotoxin A (BoNT-A) is used to manage spasticity in children with cerebral palsy (CP).
- Systemic adverse events (SAEs) following BoNT-A injections, though rare, are a concern.
- Identifying predictive factors for SAEs is crucial for patient safety.
Purpose of the Study:
- To identify pre-injection factors associated with an increased likelihood of systemic adverse events (SAEs) after botulinum neurotoxin A (BoNT-A) injections in children with cerebral palsy (CP).
Main Methods:
- A prospective observational study was conducted from 2010-2014 at a tertiary pediatric hospital.
- Systemic adverse events (e.g., respiratory illness, weakness, dysphagia, death) were recorded.
- Univariable and multivariable logistic regression analyses examined the relationship between SAEs and eight pre-injection variables.
Main Results:
- Out of 2219 injection episodes, 77 (3.6%) reported SAEs.
- Univariable analysis indicated that higher Gross Motor Function Classification System (GMFCS) levels, dysphagia, gastrostomy, aspiration pneumonia, and higher BoNT-A dose were associated with SAEs.
- Multivariable analysis confirmed that a history of dysphagia (OR 3.42) and/or aspiration pneumonia (OR 2.31) were significantly associated with increased SAE likelihood.
Conclusions:
- A history of dysphagia and/or aspiration pneumonia are the primary risk factors for systemic adverse events following BoNT-A injections in children with CP.
- No significant association was found between GMFCS level or BoNT-A dose and SAEs in the multivariable analysis.
- These findings aid in risk stratification and informed decision-making for BoNT-A therapy in pediatric CP patients.
Aim:
To identify factors that increase the likelihood of systemic adverse events after botulinum neurotoxin A (BoNT-A) injections in children with cerebral palsy (CP).
Method:
A prospective observational study of patients attending a BoNT-A clinic at a tertiary paediatric hospital (2010-2014). Occurrences of systemic adverse events, defined as lower respiratory tract illnesses, generalized weakness, dysphagia, and death were determined at follow-up. The relationship between systemic adverse events and eight preinjection variables (age, Gross Motor Function Classification System [GMFCS] level, history of dysphagia, gastrostomy, aspiration pneumonia, recent history of illness, BoNT-A dose, and type of sedation) were examined using univariable and multivariable logistic regression with generalized estimating equations methods.
Results:
In total 591 children underwent 2219 injection episodes with follow-up in 2158 (97%) cases. Systemic adverse events were reported in 77 (3.6%) injection episodes. Univariable analysis suggested that GMFCS levels IV and V, a history of dysphagia, gastrostomy, aspiration pneumonia, and increasing BoNT-A dose increase the likelihood of systemic adverse events. In multivariable analysis, a history of dysphagia (odds ratio [OR] 3.42) and/or aspiration pneumonia (OR 2.31) remained associated with increased likelihood of systemic adverse events.
Interpretation:
A history of dysphagia and/or aspiration pneumonia are the factors that most increase the likelihood of systemic adverse events after BoNT-A.
What This Paper Adds:
Systemic adverse events occur in 3.6% of botulinum neurotoxin A (BoNT-A) injection episodes. Dysphagia and/or aspiration pneumonia are associated with increased likelihood of systemic adverse events. Multivariable models showed no evidence of association between Gross Motor Function Classification System and systemic adverse events. Multivariable models showed no evidence of association between BoNT-A dose and systemic adverse events.
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