title: Botulinum toxin type A treatment in children with cerebral palsy: evaluation of treatment success or failure by means of goal attainment scaling.
abstract: BACKGROUND
  There is considerable variability in the amount of response to BTX-A treatment between and within patients with cerebral palsy (CP).
  
  
  OBJECTIVE
  The purpose of this retrospective cohort study was to evaluate the clinical responsiveness of Botulinum toxin type A (BTX-A) treatment in children with CP and specifically delineate features of treatment success and failure.
  
  
  METHODS
  Four hundred and thirty-eight children (251 boys, 187 girls; mean age 8 years 2 months, SD 4 years) were included into the study. Goal Attainment Scaling (GAS) was used to classify and evaluate treatment efficacy. Two study groups were defined: one group with an excellent response (GAS≥60.0) and one group with a lack of response (GAS≤40.0) to BTX-A.
  
  
  RESULTS
  Seventy-five patients (17.1%) had an excellent response and treatment was found to be unsuccessful for 31 patients (7.1%). Children with a lack of response to BTX-A were significantly older compared to children with a high responsiveness (p=0.0013). In the latter group, more children received multi-level injections and fewer children had injections in proximal parts of the lower limb compared to the low responsiveness group (p=0.0024). Moreover, there was a significant difference in the use of different types of casts between both study groups (p=0.0263).
  
  
  CONCLUSIONS
  Age, level of treatment and casting seem to be crucial features of BTX-A treatment success or failure in children with CP.
authors.affiliation: Clinical Motion Analysis Laboratory, UZ Pellenberg, Belgium. kaat.desloovere@uzleuven.be
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
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: Guy
authors.initials: G
authors.lastname: Molenaers
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A