title: Botulinum toxin treatment in upper limb spasticity: treatment consistency.
abstract: This study assessed treatment consistency of botulinum toxin administration in spastic upper limbs under pragmatic conditions, as derived through stability of dosages and between injections intervals. Over a period of 8 years, 153 children (81 with bilateral spastic cerebral palsy, 72 with unilateral) were treated according to accepted, experience-based guidelines with Botox and Dysport. Treatment response was based on assessment of spasticity and attainment of pre-determined goals at 3, 6 and 12 months post each treatment. Mean age at treatment onset was 6y 4mo (SD: 4y 10mo), median F/U, 2.5 years (4 months-6 8/12 years). Number of injection sessions was 1-10; few had more than 6 sessions. In 106 (69.28%) children, more than one anatomic regions of the limb were injected. Most (56.2%), had at least two injection sessions; median time interval between the sessions was 9 months (IQR: 4-35 months, similar for unilateral and bilateral cerebral palsy, p = 0.874). Children >4 years old at the first treatment had longer intervals between sessions (25.8%) compared to younger ones (p = 0.010). The mixed effects models demonstrated that botulinum toxin dosage was stable over subsequent visits (p = 0.144) and that intermediate intervals for subsequent visits were similar to the first one (p = 0.279).
authors.affiliation: Department of Neurology, Pendeli Children's Hospital, 8 Hippocrates street, Palia Pendeli, 15236 Athens, Greece. theon@otenet.gr
authors.forename: Antigone S
authors.initials: AS
authors.lastname: Papavasiliou
authors.forename: Irene
authors.initials: I
authors.lastname: Nikaina
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Bouros
authors.forename: Ioanna
authors.initials: I
authors.lastname: Rizou
authors.forename: Constantine
authors.initials: C
authors.lastname: Filiopoulos
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D034941:Upper Extremity
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA