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Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy

SCHASFOORT F; DALLMEIJER A; PANGALILA R; CATSMAN C; STAM H; BECHER J; STEYERBERG E; POLINDER S; BUSSMANN J
J REHABIL MED , 2018, vol. 50, n° 1, p. 22-29
Doc n°: 186841
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.2340/16501977-2267
Descripteurs : AD32 - SPASTICITE, AJ23 - PARALYSIE CEREBRALE

Despite the widespread use of botulinum toxin in ambulatory children
with spastic cerebral palsy, its value prior to intensive physiotherapy with
adjunctive casting/orthoses remains unclear. DESIGN:
A pragmatically designed,
multi-centre trial, comparing the effectiveness of botulinum toxin + intensive
physiotherapy with intensive physiotherapy alone, including economic evaluation.
PATIENTS: Children with spastic cerebral palsy, age range 4-12 years,
cerebral palsy-severity Gross Motor Function Classification System levels I-III,
received either botulinum toxin type A + intensive physiotherapy or intensive
physiotherapy alone and, if necessary, ankle-foot orthoses and/or casting.
METHODS: Primary outcomes were gross motor func-tion, physical activity levels,
and health-related quality-of-life, assessed at baseline, 12 (primary end-point)
and 24 weeks (follow-up). Economic outcomes included healthcare and patient
costs. Intention-to-treat analyses were performed with linear mixed models.
RESULTS: There were 65 participants (37 males), with a mean age of 7.3 years
(standard deviation 2.3 years), equally distributed across Gross Motor Function
Classification System levels. Forty-one children received botulinum toxin type A
plus intensive physio-therapy and 24 received intensive physiotherapy treatment
only. At primary end-point, one statistically significant difference was found in
favour of intensive physiotherapy alone: objectively measured percentage of
sedentary behaviour (-3.42, 95% confidence interval 0.20-6.64, p=0.038).
Treatment costs were significantly higher for botulinum toxin type A plus
intensive physiotherapy (8,963 vs 6,182 euro, p=0.001). No statistically
significant differences were found between groups at follow-up. CONCLUSION: The
addition of botulinum toxin type A to intensive physiotherapy did not improve the
effectiveness of rehabilitation for ambulatory children with spastic cerebral
palsy and was also not cost-effective. Thus botulinum toxin is not recommended
for use in improving gross motor function, activity levels or health-related
quality-of-life in this cerebral palsy age- and severity-subgroup.

Langue : ANGLAIS

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