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. 2017 Dec 11;18(1):520.
doi: 10.1186/s12891-017-1880-y.

Treatment with Botulinum toxin A in a total population of children with cerebral palsy - a retrospective cohort registry study

Maria Franzén  1 , Gunnar Hägglund  2 , Ann Alriksson-Schmidt  2
Affiliations

Treatment with Botulinum toxin A in a total population of children with cerebral palsy - a retrospective cohort registry study

Maria Franzén et al. BMC Musculoskelet Disord. .

Abstract

Background: Botulinum toxin A (BTX-A) has been used to reduce spasticity in children with cerebral palsy (CP) for decades. The purpose of this study was to analyze to what extent BTX-A treatment was used to treat spasticity in a total population of children with CP. We investigated 1) the use of BTX-A in relation to age, sex, and Gross Motor Function Classification System (GMFCS) level, 2) the most common muscle groups treated with BTX-A in relation to the same variables, and 3) changes in the proportions of children treated with BTX-A between two time points (2010 and 2015).

Methods: The study was based on data from CPUP, a combined Swedish follow-up program and national healthcare registry, comprising >95% of all children with CP in Sweden. The participants (N = 3028) were born in 2000 or later. Potential BTX-A treatment and treated muscle groups were included from all CPUP assessments recorded in the registry in 2014-2015. In Aim 3, BTX-A administration in 3-5 year-olds at two time points was assessed. Crosstabs and 95% confidence intervals (CIs) for binominal proportions were calculated and logistic regression was used to regress age, sex, and GMFCS level on BTX-A treatment. Muscle groups treated with BTX-A were assessed using crosstabs and 95% CIs. Proportional change in BTX-A treatment over a 5-year period was analyzed using chi-square.

Results: We included 3028 children (57% boys; median age 7 years) of whom 26% received BTX-A. Significantly more boys (28%) than girls (23%) received BTX-A (OR = 1.25, [95% CI 1.05-1.48]). Significant differences were found for age and GMFCS levels; 4-6 year-olds and those at GMFCS III-IV were more likely to receive BTX-A. BTX-A treatment in the gastrocnemius muscle was most common in the 4-6 year-olds and at GMFCS I-III, whereas treatment of the hamstring and adductor muscles was more common in older children and at GMFCS IV-V. No significant change in the proportion of BTX-A administered in 2010 and 2015 was demonstrated.

Conclusions: BTX-A treatment differed based on age, sex, and GMFCS level. Proportion of BTX-A treatment in Sweden has remained stable during the past five years.

Keywords: Age; Botulinum toxin a; CPUP; Cerebral palsy; GMFCS level; Registry; Sex; Spasticity.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Board at Lund University (LU 443–99, revised 2009), and permission was obtained to extract data from the CPUP registry. Verbal consent to use data for research was provided by all families participating in CPUP.

Consent for publication

Not applicable. This study is based on aggregated data from all children reported to CPUP, Swedish Cerebral Palsy Surveillance Program and National Healthcare Registry.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Assessment schedule for CPUP
Fig. 2
Fig. 2
Flowchart of study inclusion
Fig. 3
Fig. 3
BTX-A treatment in relation to age. Proportion of children (%) treated with BTX-A based on age. The line segments represent the upper and lower bounds of the 95% confidence intervals. N = 3028
Fig. 4
Fig. 4
BTX-A treatment in relation to GMFCS level. Proportion of children (%) treated with BTX-A based on GMFCS level. The line segments represent the upper and lower bounds of the 95% confidence intervals. N = 3028
Fig. 5
Fig. 5
BTX-A treatment based on muscle groups and age. Proportion of children (%) treated with BTX-A based on muscle groups and age. The line segments represent the upper and lower bounds of the 95% confidence intervals. N = 776
Fig. 6
Fig. 6
BTX-A treatment based on muscle groups and GMFCS level. Proportion of children (%) treated with BTX-A based on muscle groups and GMFCS level. The line segments represent the upper and lower bounds of the 95% confidence intervals. N = 776
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