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Functional classification systems and their association with botulinum toxin type a use in pediatric cerebral palsy

Duygu Kurtuluş1, Gokhan Basar2, Ozlem Kaleoglu2

  • 1Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Üsküdar University, Memorial Ataşehir Hospital, Istanbul, Türkiye. dygkurtulus@gmail.com.

Scientific Reports
|July 1, 2026
PubMed

Insights

Botulinum toxin type A (BoNT-A) treatment for children with cerebral palsy (CP) is linked to greater upper limb dysfunction. Manual Ability Classification System (MACS) scores, not communication or global motor function, predicted BoNT-A use in this study.

Area of Science:

  • Pediatric Neurology
  • Rehabilitation Medicine
  • Clinical Effectiveness Research

Background:

  • Botulinum toxin type A (BoNT-A) is a primary treatment for spasticity in pediatric cerebral palsy (CP).
  • The specific functional factors influencing BoNT-A administration remain unclear.
  • Understanding these factors is crucial for optimizing treatment strategies and rehabilitation goals.

Purpose of the Study:

  • To investigate the association between standardized functional classification levels and BoNT-A administration in children with CP.
  • To determine if manual, motor, or communication functional domains predict BoNT-A use in clinical practice.

Main Methods:

  • A cross-sectional study involving 52 children with spastic hemiplegic and diplegic CP.
  • Functional status assessed using the Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), and Korean-Modified Functional Severity Score (KMFSS).
  • Multivariable logistic regression analysis adjusted for age and sex.

Main Results:

  • Children receiving BoNT-A showed significantly greater manual dysfunction (MACS: 3.0 [2.0-4.0]) compared to those not receiving it (MACS: 2.0 [1.0-3.5], p=0.016).
  • No significant differences in CFCS or KMFSS were found between groups.
  • MACS level was the sole significant predictor of BoNT-A administration (β = -0.721, p=0.036) in multivariable analysis.

Conclusions:

  • BoNT-A use in pediatric CP is more strongly associated with upper limb functional impairment (manual dysfunction) than with broader motor or communication classifications.
  • This suggests a potential disconnect between focal assessments and global functional status in clinical decision-making.
  • Further prospective research with larger cohorts is warranted to validate these findings.

Keywords:
botulinum toxincerebral palsyfunctional classificationpediatric rehabilitationspasticity

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