Botulinum toxin for sixth nerve palsies in children with brain tumors

Abstract

Purpose: Sixth nerve palsies in children with brain tumors have a low rate of spontaneous recovery. Botulinum toxin has been used to treat sixth nerve palsies. In this study, we review outcomes for children with brain tumors and sixth nerve palsies, some of whom were treated with botulinum toxin.

Methods: To determine whether botulinum toxin effected the outcome of children with sixth nerve palsies and brain tumors, a retrospective review of charts was conducted for patients identified as having brain tumors and sixth nerve palsies after evaluation at the St Jude Children's Research Hospital Eye Clinic between 1992 and 1999. Of 48 charts identified, 19 met our inclusion criteria, having a record of brain tumor associated with sixth nerve palsy and 2 or more eye clinic visits at least 6 months apart. Children were considered recovered if they had an esotropia of less than 10 PD in primary gaze at the last follow-up visit and did not require surgical correction.

Results: Of the 19 children included in the study, 10 were managed conservatively (no botulinum toxin or surgery for at least 6 months after diagnosis). Nine children received one or more botulinum toxin injections. Two (20%) of the 10 children in the conservatively managed group recovered without surgical intervention. Two (22%) of the 9 children in the botulinum toxin treatment group recovered without surgical intervention.

Conclusions: Treatment with botulinum toxin did not improve the rate of recovery in our series of children with brain tumors and sixth nerve palsies.