title: Long-term use of botulinum toxin type A in children with cerebral palsy: treatment consistency.
abstract: At the University Hospital of Pellenberg (Belgium), more than 1000 patients have been treated with Botulinum toxin type A (BTX-A) over the last decade. Ten percent of these patients (n=106) received multiple (at least four times), multi-level, high-dosage treatments. The aim of this study was to evaluate the stability of dosage and treatment intervals in long-term, multi-level, high-dosage treated children with cerebral palsy and to evaluate the evidence for a safe and stable response to this treatment. Data on disease, age, dosage and target muscles were extracted for each treatment session of 106 patients who received multiple BTX-A treatment sessions. Patients had a follow-up of 4y 6mo (range 1y 8mo-8y 9mo) on average and received 4 to 12 BTX-A treatments within the period of January 1996 and December 2005. Patients received a mean dosage of 23.5+/-5.2U/kgbw at first treatment with stable subsequent values. Mean dosages for children with diplegia, hemiplegia and quadriplegia were 24.5+/-4.7U/kgbw, 15.9+/-3.7U/kgbw and 22.0+/-4.8U/kgbw, respectively. Mean age at first treatment was 4y 6mo (range 1y 11mo-18y 10mo) with a majority of patients (76.4%) first treated within 2 and 4y of age. Treatment intervals of approximately 1y remained stable within four, five and six subsequent treatments. Long-term, high-dosage, multi-level BTX-A applications can be considered as a safe and stable treatment option for children with cerebral palsy and the formation of antibodies, responsible for secondary non-response, can be indirectly precluded.
authors.affiliation: Department of Paediatric Orthopaedics, UZ Pellenberg, Belgium; Musculoskeletal Sciences, KU-Leuven, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Molenaers
authors.forename: Verena
authors.initials: V
authors.lastname: Schörkhuber
authors.forename: Katrien
authors.initials: K
authors.lastname: Fagard
authors.forename: Anja
authors.initials: A
authors.lastname: Van Campenhout
authors.forename: Jos
authors.initials: J
authors.lastname: De Cat
authors.forename: Petra
authors.initials: P
authors.lastname: Pauwels
authors.forename: Els
authors.initials: E
authors.lastname: Ortibus
authors.forename: Paul
authors.initials: P
authors.lastname: De Cock
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
mesh_terms: D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019635:Neurosurgical Procedures; D010243:Paralysis / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A