GMFCS level improvement in children with cerebral palsy treated with repeat botulinum toxin injections and intensive rehabilitation: A retrospective study.

PURPOSE: The Gross Motor Functional Classification System (GMFCS) provides a standardized classification of motor disability in children with cerebral palsy (CP) that is typically considered longitudinally stable. Here, changes in GMFCS levels of children with CP who received repeated botulinum toxin A (BoNT-A) injections within an intensive rehabilitation approach were evaluated. METHODS: This retrospective, observational study included 503 children with CP (GMFCS I-V) treated in a single university rehabilitation clinic. Individualized treatment plans and a variety of rehabilitation techniques were incorporated within an integrated model of care. Each child received≥2 repeated BoNT-A injections as well as an intensive rehabilitation program. RESULTS: GMFCS level following repeat treatment improved in 42.1% of the patients and worsened in 3 patients; 14.9% of children showed improvement after 1 treatment cycle, 12.3% after 2 cycles, 7.6% after 3 cycles, 3.6% after 4 cycles, and 3.8% after≥5 cycles. Type of involvement (p < 0.001), baseline GMFCS (p = 0.001), number of treatment cycles (p < 0.001) and presence of severe dystonia (p = 0.032) were significant predictors of GMFCS improvement, but age and gender were not. CONCLUSION: Children with CP may change GMFCS level when intensive rehabilitation programs are combined with repeated BoNT-A injections.

Switching from onabotulinumtoxin-A to abobotulinumtoxin-A in children with cerebral palsy treated for spasticity: A retrospective safety and efficacy evaluation.

OBJECTIVES: To determine whether switching from onabotulinumtoxinA to abobotulinumtoxinA in children with cerebral palsy is safe and whether therapeutic efficacy is maintained. METHODS: This retrospective observational study of routine care included 118 children with cerebral palsy (mean age 81.4 months (standard deviation; SD 38.9)) who had switched from onabotulinumtoxinA to abobotulinumtoxinA injections into their lower extremities due to a change in hospital policy. Analysis was limited to the final onabotulinumtoxinA treatment-cycle prior to switch, and the first abobotulinumtoxinA treatment-cycle following switch. The primary objective was to document the safety and tolerability of switching products. Efficacy endpoints included muscle tone, spasticity, and gait function based on Modified Ashworth Scale (MAS), Tardieu Scale (TS) and Observational Gait Scale (OGS) scores. RESULTS: Treatment-emergent adverse events were recorded in 41 (34.7%) and 31 (26.3%) patients during the onabotulinumtoxinA and abobotulinumtoxinA treatment cycles, respectively. Treatment-related adverse events were reported in 5 patients in the onabotulinumtoxinA treatment-cycle vs 7 in the abobotulinumtoxinA treatment-cycle (p?=?0.774). Treatment efficacy (4–6 weeks post-treatment) was similar in the onabotulinumtoxinA and abobotulinumtoxinA treatment-cycles for all variables (MAS, TS, OGS). CONCLUSION: In children with cerebral palsy, switching from onabotulinumtoxinA to abobotulinumtoxinA is safe and generally well-tolerated and therapeutic efficacy is maintained.