title: Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement.
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.
authors.affiliation: Bloorview Research Institute, Bloorview Kids Rehab, Department of Paediatrics, University of Toronto, Toronto, ON, Canada. dfehlings@bloorview.ca
authors.forename: D
authors.initials: D
authors.lastname: Fehlings
authors.forename: I
authors.initials: I
authors.lastname: Novak
authors.forename: S
authors.initials: S
authors.lastname: Berweck
authors.forename: B
authors.initials: B
authors.lastname: Hoare
authors.forename: N S
authors.initials: NS
authors.lastname: Stott
authors.forename: R N
authors.initials: RN
authors.lastname: Russo
mesh_terms: D000293:Adolescent; D001132:Arm / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology*; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D016903:Drug Monitoring / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D038622:Internationality; D009122:Muscle Hypertonia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017063:Outcome Assessment, Health Care / Q000379:methods; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D014463:Ultrasonography
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins