Botulinum toxin-A use in paediatric hypertonia: Canadian practice patterns.
BACKGROUND
This study aims to assess current practices of Canadian physicians providing botulinum toxin-A (BoNT-A) treatments for children with hypertonia and to contrast these with international "best practice" recommendations, in order to identify practice variability and opportunities for knowledge translation.


METHODS
Thirteen Canadian physicians assembled to develop and analyze results of a cross-sectional electronic survey, sent to 50 physicians across Canada.


RESULTS
Seventy-eight percent (39/50) of physicians completed the survey. The most frequently identified assessment tools were Gross Motor Function Classification System, Modified Tardieu Scale and neurological examination. Goal-setting tools were infrequently utilized. Common indications for BoNT-A injections and the muscles injected were identified. Significant variability was identified in using BoNT-A for hip displacement associated with hypertonia. The most frequent adverse event reported was localized weakness; 54% reporting this "occasionally" and 15% "frequently". Generalized weakness, fatigue, ptosis, diplopia, dysphagia, aspiration, respiratory distress, dysphonia and urinary incontinence were reported rarely or never. For dosage, 52% identified 16 Units/kg body weight of Botox® as maximum. A majority (64%) reported a maximum 400 Units for injection at one time. For localization, electrical stimulation and ultrasound were used infrequently (38% and 19% respectively). Distraction was the most frequently used pain-management technique (64%).


CONCLUSIONS
Canadian physicians generally adhere to international best practices when using BoNT-A to treat paediatric hypertonia. Two knowledge-translation opportunities were identified: use of individualized goal setting prior to BoNT-A and enhancing localization techniques. Physicians reported a good safety profile of BoNT-A in children.
Department of Paediatrics, University of Toronto, Toronto, Canada. dfehlings@hollandbloorview.ca
D
D
Fehlings
U
U
Narayanan
J
J
Andersen
R
R
Beauchamp
J W
JW
Gorter
A
A
Kawamura
G
G
Kiefer
M
M
Mason
A
A
McCormick
R
R
Mesterman
L
L
Switzer
J
J
Watt
D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009122:Muscle Hypertonia / Q000188:drug therapy* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010147:Pain Measurement; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A