Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity international consensus statement

D Fehlings, I Novak, S Berweck, B Hoare, N Stott, Remo Russo

    Research output: Contribution to journalReview articlepeer-review

    62 Citations (Scopus)

    Abstract

    The primary objective of this paper was to evaluate the published evidence of efficacy and safety of botulinum neurotoxin (BoNT) injections in paediatric upper limb hypertonia (PULH). Secondary objectives included the provision of clinical context, based on evidence and expert opinion, in the areas of assessment, child and muscle selection, dosing, and adjunctive treatment. A multidisciplinary panel of authors systematically reviewed, abstracted, and classified relevant literature. Recommendations were based on the American Academy of Neurology (AAN) evidence classification. Following a literature search, 186 potential articles were screened for inclusion, and 15 of these met the criteria and were reviewed. Grade A evidence was found to support the use of BoNT to reach individualized therapeutic goals for PULH. There is grade B evidence (probably effective) for tone reduction following BoNT injections and grade U evidence (inconclusive) for improvement in upper limb (UL) activity and function. BoNT injections were generally found to be safe and well tolerated with the most common side effect identified as a transient decrease in grip strength.

    Original languageEnglish
    Pages (from-to)38-56
    Number of pages19
    JournalEuropean Journal of Neurology
    Volume17
    Issue numberSUPPL. 2
    DOIs
    Publication statusPublished - Aug 2010

    Keywords

    • assessment
    • botulinum toxin A
    • children
    • hypertonicity
    • occupational therapy
    • spasticity
    • systematic review
    • upper limb/extremity

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