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Severity of cerebral palsy and likelihood of adverse events after botulinum toxin A injections
Author(s) -
Swinney Caitlyn M,
Bau Karen,
Burton Karen L Oakley,
O'Flaherty Stephen J,
Bear Natasha L,
Paget Simon P
Publication year - 2018
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13686
Subject(s) - adverse effect , medicine , gross motor function classification system , dysphagia , incidence (geometry) , cerebral palsy , anesthesia , confidence interval , botulinum toxin , pediatrics , surgery , physical therapy , physics , optics
Aim To determine the incidence of common adverse events after botulinum toxin A (Bo NT ‐A) injections in children with cerebral palsy ( CP ) and to identify whether the severity of CP influences the incidence of adverse events. Method This was an observational study of patients attending a Bo NT ‐A clinic at a tertiary paediatric hospital (2010–2014). Data examined included procedural adverse events at the time of injection and at follow‐up. Systemic adverse events were defined as lower respiratory tract illnesses, generalized weakness, dysphagia, and death. Severity of CP was categorized by the Gross Motor Function Classification System ( GMFCS ). The relationships between GMFCS and adverse events were analysed using negative binomial regression models. Results In total, 591 children underwent 2219 injection episodes. Adverse events were reported during the procedure (130 [6%] injection episodes) and at follow‐up (492 [22%] injection episodes). There were significantly increased rates of systemic adverse events in injection episodes involving children in GMFCS level IV (incidence rate ratio [ IRR ] 3.92 [95% confidence interval] 1.45–10.57]) and GMFCS level V ( IRR 7.37 [95% confidence interval 2.90–18.73]; p <0.001). Interpretation Adverse events after Bo NT ‐A injections are common but mostly mild and self‐limiting. Children in GMFCS levels IV and V are at increased risk of systemic adverse events. The relationship between CP severity and Bo NT ‐A adverse events is complex and further research is required to better understand this relationship. What this paper adds Adverse events reported at the time of botulinum toxin A injection occurred in 6% of injection episodes. Adverse events were reported at follow‐up in 22% of injection episodes. Children in Gross Motor Function Classification System (GMFCS) levels IV and V have increased rates of systemic adverse events. Children in GMFCS levels IV and V report less local weakness and pain.