Parent-proxy ratings of pain before and after botulinum toxin type A treatment for children with spasticity and cerebral palsy.

OBJECTIVE: To test the hypothesis that pain would be reduced after botulinum toxin type A (Btx/A) treatment for children with cerebral palsy (CP). METHOD: Thirty-four pediatric patients with CP (mean age 9 y; 56% male) and their parents were recruited through a regional specialty healthcare center medical clinic and pain research program. A 1-group pretest, posttest treatment design was used on the basis of a standardized parent-proxy report of their child's pain. RESULTS: Overall parent ratings of their child's pain were significantly reduced after Btx/A injection with 62% of parents reporting the absence of pain 1 month after injection (proportion=0.38; 95% confidence interval=0.23-0.55). There were no significant differences for males or females. CONCLUSIONS: Although there is considerable evidence that Btx/A is efficacious for the treatment of spasticity associated with CP, there is little direct evidence specific to associated analgesic effects after Btx/A treatment. These preliminary findings indicate that Btx/A treatment for spasticity resulted in significant pain reduction for this patient sample. This was the first study to directly ask parents about their child's pain pre-Btx/A and post-Btx/A treatment. These findings have implications for the management of pain associated with spasticity and CP and suggest further research is warranted.

Complex dosing schedules for continuous intrathecal baclofen infusion.

The objective of the present study was to understand the clinical reasons for changes from simple continuous to complex (flex) dosing for tone reduction in individuals receiving intrathecal baclofen. Methodology was a retrospective chart review study of 164 individuals (95 male, 69 female) at a multi-specialty children's hospital who were followed for at least 1 year for intrathecal baclofen management. Eighty-two persons were in the simple continuous only group and 82 also were on complex schedules at least once during the follow-up period. Mean age at most recent follow-up was 18 years and 0 months (median, 15 years and 8 months; standard deviation, 8 years and 0 months; range, 6-45). The top three clinical reasons for switching dosing method were to (1) optimize intrathecal baclofen effect, (2) treat predictable daily tone variation, and (3) manage signs and symptoms of intrathecal baclofen withdrawal or underdelivery. In both groups, 90% of individuals had cerebral palsy, and mean baseline leg Ashworth scores were the same in both groups (mean, 3.7; standard deviation, 0.7). Mean total daily dose at chart review was higher in complex dosing (429.3 vs 211.9 microg/day), as was mean follow-up time (4.8 vs 3.9 years). Case examples are presented.

Parent evaluation of spasticity treatment in cerebral palsy using botulinum toxin type A.

OBJECTIVE: To assess parent ratings of treatment acceptability associated with botulinum toxin type A (BTX-A) injection for spasticity in children with cerebral palsy (CP). DESIGN: A single-point survey design across a sequentially recruited cohort, using a standardized evaluation measure. SETTING: Regional specialty health care center medical clinic and pain research program. PARTICIPANTS: Fifty-nine parents of children with CP receiving BTX-A injection for spasticity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Treatment Evaluation Inventory. RESULTS: Overall, parent ratings of treatment acceptability ranged from moderate to high. There were no significant differences for caregiver ratings in relation to characteristics of the raters (age, sex, marital status) or of the children (age, sex, mental retardation, severity of disability) characteristics. CONCLUSIONS: These findings indicate that on average, parents of children with CP consider BTX-A treatment for the management of spasticity to be an acceptable form of treatment.

Impact of surgeon specialty on ovarian-conserving surgery in young females with an adnexal mass.

PURPOSE: To evaluate the patterns of surgical care among pediatric and adolescent females undergoing operative intervention for an adnexal mass with particular attention toward factors associated with ovarian-conserving surgery and access to gynecologic care. METHODS: All female patients aged < or = 18 years undergoing surgery for an adnexal mass between January 1, 1991 and December 31, 2002 were retrospectively identified and demographic, operative, and pathologic data abstracted. Logistic regression analyses were used to identify factors independently associated with ovarian-conserving surgery and access to gynecologic care. RESULTS: Eighty-two consecutive cases were identified. The median age at surgery was 15 years, and 91.7% of patients were > or = 12 years of age. A malignant ovarian neoplasm was present in 14.6% of cases. Oophorectomy was performed in 52.4% of cases, while 47.6% of patients underwent ovarian-conserving surgery. Multivariate regression analysis revealed that ovarian-conserving surgery was significantly less likely in the setting of malignancy, torsion, and an ovarian size of > or = 6 cm. The presence of a gynecologic surgeon, compared to other surgical specialties, was statistically significantly and independently associated with ovarian-conserving surgery (odds ratio [OR] 8.71, 95% confidence interval [CI] 2.12-41.41, p = .001). Post-menarchal status and age > or = 16 years were the characteristic most predictive of access to gynecologic surgical care. CONCLUSIONS: In pediatric and adolescent patients, operative intervention for an adnexal mass is significantly more likely to result in ovarian conservation when performed by a gynecologic surgeon. For such patients, improved access to gynecologic consultation prior to surgical intervention may reduce the number of patients subjected to oophorectomy for benign conditions.