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Physical characteristics and upper-limb treatment with botulinum neurotoxin A in children with cerebral palsy: A
Jenny Hedberg-Graff1, Fredrik Granström2, Lena Krumlinde-Sundholm1
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Children with cerebral palsy (CP) receiving botulinum neurotoxin A (BoNT-A) for upper-limb treatment often start before age 4. Full passive range of motion with tightness is linked to receiving this treatment.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Movement Disorders
Background:
- Cerebral palsy (CP) affects motor function in children.
- Upper-limb spasticity is a common challenge in CP.
- Botulinum neurotoxin A (BoNT-A) is a therapeutic option for managing upper-limb spasticity.
Purpose of the Study:
- To describe the utilization of upper-limb botulinum neurotoxin A (BoNT-A) treatment in a population-based sample of children with CP.
- To identify factors associated with the first upper-limb BoNT-A treatment.
- To investigate the relationship between passive range of motion (ROM) and first upper-limb BoNT-A treatment, adjusting for confounders.
Main Methods:
- Utilized data from the Swedish national CP registry (CPUP) for children with spastic or dyskinetic CP (2000-2017).
- Analyzed CP subtypes, functional levels (Manual Ability Classification System), and passive ROM categories.
- Employed logistic regression to determine odds ratios for receiving first upper-limb BoNT-A treatment.
Main Results:
- 22% of 496 children received upper-limb BoNT-A, with 45% starting before age 4.
- Children in Manual Ability Classification System levels IV and V had higher odds of receiving treatment.
- Full passive ROM with tightness at the end of movement was significantly associated with receiving first upper-limb BoNT-A treatment, even after adjustment.
Conclusions:
- Full passive range of motion with tightness is a key indicator for initiating upper-limb BoNT-A treatment in children with CP.
- This finding introduces a new consideration for treatment decisions regarding upper-limb BoNT-A.
- Thumb and forearm muscles were the primary targets for initial BoNT-A injections.
Aim:
To describe the use of upper-limb botulinum neurotoxin A (BoNT-A) treatment in a population-based sample of children with cerebral palsy (CP), by investigating whether factors may be related to a first upper-limb BoNT-A treatment and whether passive range of motion (ROM) is related to a first BoNT-A treatment after adjustment for confounders.
Method:
Data from five regions in Sweden, in the national registry and follow-up programme for CP (CPUP), were collected for children with spastic or dyskinetic CP assessed between 2000 and 2017. CP subtypes, functional classification levels, and traffic-light-based passive ROM categories were investigated. Data were analysed with logistic regression (odds ratios).
Results:
Of a total of 496 children (317 males, 179 females; median 2 years, interquartile range 1-5 years, range 1-15 years at first measurement occasion), 22% (n = 108) had received upper-limb BoNT-A treatment, 45% of whom by 1 to 3 years of age. Those classified in Manual Ability Classification System levels IV and V showed the highest crude odds ratio for a first upper-limb BoNT-A treatment. Children with full passive ROM with tightness at the end of the movement range were most likely to receive an upper-limb BoNT-A treatment, also after adjustment for confounders. Thumb and forearm muscles were the most targeted at the first upper-limb BoNT-A treatment.
Interpretation:
Full passive ROM with tightness at the end of the movement range increases the likelihood of a first upper-limb BoNT-A treatment. This new traffic-light category is an aspect to consider in the dialogue about upper-limb BoNT-A.
What This Paper Adds:
Among children receiving upper-limb botulinum neurotoxin A (BoNT-A), 45% had their first treatment before the age of 4 years. Thumb and forearm muscles were the most treated with BoNT-A, finger flexor muscles the least. Full passive range of motion with tightness was related to first upper-limb BoNT-A treatment.
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