title: Use of rimabotulinum toxin for focal hypertonicity management in children with cerebral palsy with nonresponse to onabotulinum toxin.
abstract: OBJECTIVE
  The aim of this study was to review the effect of rimabotulinum toxin (BoNT-B) for focal hypertonicity management in children with cerebral palsy and secondary nonresponse to onabotulinum toxin treated at the authors' tertiary care academic medical center.
  
  
  METHODS
  A retrospective review of the medical treatment of children was conducted at the authors' institution (March 16, 2001, to August 2, 2002) using the key words botulinum toxin B and Myobloc (Solstice Neurosciences Inc, South San Francisco, CA). Demographic information was analyzed using descriptive statistics (number [percentage] and mean [range]). The Pearson χ test was used to evaluate differences in incidence of adverse events.
  
  
  RESULTS
  Eighty-two children had BoNT-B injections (116 treatments). Overall, 26.8% (19/71) of the children or their parents/guardians reported no or minimal response to the injections, with 89.5% (17/19) of these children having secondary nonresponse to onabotulinum toxin. Adverse events were frequent but did not require hospitalization of any patient. No significant differences were found in incidence of adverse events related to BoNT-B dosing, medical fragility, or Gross Motor Function Classification System level.
  
  
  CONCLUSIONS
  More than one-fourth of the children receiving BoNT-B injections had nonresponse, with most having previous nonresponse to onabotulinum toxin. Adverse events related to BoNT-B injections were frequent and unpredictable but not severe.
authors: From the Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis (JEB, LEK); and Department of Pediatric Physical Medicine and Rehabilitation, Gillette Children's Specialty Healthcare, St Paul, Minnesota (LEK, MEG).
authors: Joline E
authors: JE
authors: Brandenburg
authors: Linda E
authors: LE
authors: Krach
authors: Mark E
authors: ME
authors: Gormley
mesh_terms: D000293:Adolescent; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007273:Injections, Intramuscular; D009122:Muscle Hypertonia / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D018726:Anti-Dyskinesia Agents; C096323:rimabotulinumtoxinB; D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A
references: J Child Neurol. 2007 Jan;22(1):116-22
references: 17608320
references: J Neural Transm (Vienna). 2008;115(4):631-5
references: 18250951
references: Am J Phys Med Rehabil. 2006 Dec;85(12):1011-3
references: 17033594
references: Ophthalmic Plast Reconstr Surg. 2006 May-Jun;22(3):173-7
references: 16714924
references: J Bone Joint Surg Am. 2008 Jan;90(1):23-33
references: 18171954
references: Dev Med Child Neurol. 2010 Feb;52(2):139-44
references: 20412252
references: Neurology. 2010 Jan 26;74(4):336-43
references: 20101040
references: Am J Phys Med Rehabil. 2008 Jul;87(7):556-66
references: 18574347
references: Eur J Neurol. 2009 Dec;16(12):1299-304
references: 19566902
references: Neurology. 1997 Sep;49(3):701-7
references: 9305326
references: Neurotox Res. 2006 Apr;9(2-3):121-5
references: 16785108
references: Pediatr Neurol. 2004 Aug;31(2):109-13
references: 15301829
references: Arch Phys Med Rehabil. 2004 May;85(5):705-9
references: 15129392
references: Dev Med Child Neurol. 2007 Nov;49(11):823-9
references: 17979860
references: Dev Med Child Neurol. 2011 Feb;53(2):125-30
references: 21244412
references: J Neurol. 2003 Aug;250(8):967-9
references: 12928917
references: J Neurol. 2005 Aug;252(8):904-7
references: 15761672
references: Arch Dis Child. 1998 Sep;79(3):271-3
references: 9875028
references: Clin Rehabil. 2009 May;23(5):394-407
references: 19389744