title: Botulinum toxin type A injections can be an effective treatment for pain in children with hip spasms and cerebral palsy.
abstract: OBJECTIVE
  Botulinum toxin type A (BoNT-A) injections were used in the treatment of lower-limb spasticity in children with cerebral palsy (CP). Anecdotal evidence suggests a reduction in pain after this treatment in children who had pain localized to a displaced hip joint. We report on our current clinical practice.
  
  
  METHODS
  Twenty-six children with non-ambulant quadriplegic CP (Gross Motor Function Classification System level V) were assessed as having significant spasticity and pain at the hip level. Twelve were males and 14 females, with an age range of 2 to 19 years (mean age 11y 6mo, SD 4y 9mo). Ten had functional difficulties secondary to predominant spasticity and 16 had a mix of a high-background peripheral tone with superimposed dystonia. Of the 26 children assessed, 10 had at least one hip which was dislocated and three had at least one hip which was subluxed. As part of their spasticity management programme they received targeted BoNT-A injections to the adductor magnus, medial hamstrings and iliopsoas muscle groups. The Paediatric Pain Profile was used as the primary outcome measure.
  
  
  RESULTS
  All had highly significant improvement in their recorded pain profile scores measured at 3 months after treatment (p<0.001). There was equal efficacy in response to treatment in the children with subluxed or dislocated hips. In addition, families commented on improved quality of life for the children across several areas, including sleep, postural management, and activities of daily living.
  
  
  CONCLUSIONS
  This report demonstrates that targeted BoNT-A injections reduced pain in children with significant spasticity and pain at the hip level. They may also improve quality of life of non-ambulant children with CP and a hip problem.
authors.affiliation: Evelina Children's Hospital, Lambeth Palace Road, London, UK.
authors.forename: Claire T
authors.initials: CT
authors.lastname: Lundy
authors.forename: Gary M
authors.initials: GM
authors.lastname: Doherty
authors.forename: Charlie B
authors.initials: CB
authors.lastname: Fairhurst
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006615:Hip; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A