Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study.
Anne Tabard-Fougère, Alice Bonnefoy-Mazure, Sophie Louis, Stephane Armand, Geraldo De Coulon, Oscar Vazquez
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引用次数: 0
Abstract
Purpose: To compare long-term upper extremity functional evolution in children with spastic cerebral palsy (CP) receiving upper limb botulinum toxin A (BoNT-A) injections versus physical therapy (PT) alone.
Method: This retrospective cohort study included children aged 5-12 years at baseline with ≥2 Assisting Hand Assessment (AHA) evaluations over ≥3 years. The primary outcome was AHA score change. Secondary outcomes included changes in maximal wrist extension and forearm supination during functional tasks, measured from standardized videos by three blinded assessors. Changes were classified using minimal clinically important difference (MCID) thresholds: 5 units (AHA), 20° (wrist extension), and 30° (supination).
Results: Eleven patients with unilateral spastic CP (BoNT-A+PT, n=5; PT alone, n=6) were included. All BoNT-A+PT patients demonstrasted AHA deterioration (Δ = -3.6 ± 2.7), versus improvements in 5/6 PT patients (Δ = +9.0 ± 6.4). Wrist extension declined in all BoNT-A+PT patients (Δ = -53° ± 19°) versus 1/5 PT patients (Δ = -4° ± 8°). Supination deteriorated in 4/5 cases of BoNT-A+PT patients (Δ = -30° ± 7°) but remained stable in all PT patients (Δ = +2° ± 9°).
Conclusion: Upper limb BoNT-A was associated with systematic long-term functional decline, while PT alone preserved or improved function.
Significance of study: These findings suggest that BoNT-A treatment may compromise long-term motor control and functional capacity, potentially influencing treatment algorithms in children with spastic cerebral palsy.
Level of evidence: III (retrospective cohort study).
期刊介绍：
Aims & Scope
The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery.
It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents.
The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology.
The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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