Baclofen and Botulinum Toxin A Use in Tone Management for Children With Cerebral Palsy: A Review of Current Literature and Research Gaps in Pre- and Perioperative Care

IF 2.1 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-08-08 DOI:10.1016/j.pediatrneurol.2025.07.018

Michael Li BSc , Naama Rozen MSc , Kate Wortley MD , Ram Mishaal MD

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引用次数: 0

Abstract

Cerebral palsy (CP) is a leading cause of motor disability in children. Many children with CP have hypertonia, and some will require orthopedic surgery. Botulinum toxin A (BoNT-A), a muscle relaxant, is commonly pre- or perioperatively injected to improve surgical outcomes and reduce postoperative pain and muscle tone. However, inconsistent evidence supporting its efficacy, potential research bias from industry sponsorship, and numerous adverse effects, such as long-term changes to muscle morphology, highlight the need for a better alternative. Preoperatively increasing the dose of oral baclofen, a first-line treatment for generalized CP-related hypertonia, may improve surgical outcomes with fewer long-term adverse effects. To date, the impact of an increased oral baclofen dose for this purpose has not yet been studied. This article reviews the current evidence on the effectiveness and safety of the three more commonly used antispastic treatments, BoNT-A, oral baclofen, and intrathecal baclofen, with the goal of trialing increased oral baclofen dose as an adjunct to surgery.

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巴氯芬和肉毒毒素A在脑瘫患儿张力管理中的应用：当前文献综述及术前和围手术期护理的研究空白

脑瘫（CP）是儿童运动障碍的主要原因。许多患有CP的儿童都有高张力，有些需要整形手术。肉毒杆菌毒素A （BoNT-A）是一种肌肉松弛剂，通常在术前或围手术期注射，以改善手术效果，减轻术后疼痛和肌肉张力。然而，不一致的证据支持其疗效，来自行业赞助的潜在研究偏差，以及许多副作用，如肌肉形态的长期变化，突出了需要更好的替代方案。术前增加口服巴氯芬（一种治疗全身性cp相关性高渗症的一线药物）的剂量，可以改善手术结果，减少长期不良反应。迄今为止，还没有研究增加口服巴氯芬剂量对这一目的的影响。这篇文章回顾了目前三种常用的抗痉挛治疗的有效性和安全性，BoNT-A，口服巴氯芬和鞘内巴氯芬，目的是试验增加口服巴氯芬剂量作为手术辅助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.