title: Effects of botulinum toxin type A on upper limb function in children with cerebral palsy: a systematic review.
abstract: OBJECTIVE
  To evaluate whether botulinum toxin type A injections improve upper limb function in children with cerebral palsy.
  
  
  METHODS
  An extensive search was carried out in PUBMED, CINAHL, PICARTA, EMBASE, PEDRO and the Cochrane Controlled Trials Register. Controlled and uncontrolled studies were included and evaluated on the basis of a best evidence synthesis.
  
  
  RESULTS
  Twelve out of 645 identified studies were included: three randomized controlled trials (RCTs) (N=64) of high methodological quality, and nine uncontrolled studies (N=107) of sufficient methodological quality. In one of the three RCTs a short-term, significant decrease of spasticity was found in favour of the botulinum toxin type A group, which was supported by five of the seven uncontrolled studies that also measured spasticity. In one RCT significant changes in range of motion were reported for wrist and thumb extension. This finding was supported by two out of seven uncontrolled studies. One RCT reported a significant improvement in activities after one month, according to the Quality of Upper Extremity Skills Test and the Pediatric Evaluation Disability Inventory, whereas five out of the nine uncontrolled studies reported an improvement in functional activities.
  
  
  CONCLUSIONS
  Insufficient evidence is found for the effects of botulinum toxin type A injections to reduce spasticity or to increase range of motion and upper limb function in children with cerebral palsy. Besides differences in treatment goals, the lack of evidence is mainly due to the use of invalid assessment instruments and insufficient statistical power to demonstrate treatment effects.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. a.reeuwijk@vumc.nl
authors.forename: Alexander
authors.initials: A
authors.lastname: Reeuwijk
authors.forename: Petra E M
authors.initials: PE
authors.lastname: van Schie
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D001132:Arm / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology*; D002648:Child; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A