Abstract
Objective
To report current evidence regarding the safety of intramuscular botulinum toxin injection
(BTI) in children with orthopedic- and neurologic-related musculoskeletal disorders
>2 years of age.
Data Sources
PubMed, Cochrane Library, and ScienceDirect, Google Scholar, and Web of Science.
Study Selection
Two reviewers independently selected studies based on predetermined inclusion criteria.
Data Extraction
Data relating to the aim were extracted. Methodologic quality was graded independently
by 2 reviewers using the Physiotherapy Evidence Database scale for randomized controlled
trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence
was determined using the modified Sackett scale.
Data Synthesis
Data of 473 infants were analyzed. Fifty-five infants had cerebral palsy, 112 had
obstetric brachial plexus palsy, 257 had clubfoot, and 44 had congenital torticollis.
No studies reported any severe adverse event that could be attributed to the BTI.
The rate of mild to moderate adverse events reported varied from 5% to 25%. Results
regarding efficacy were preliminary, dependent on the pathology, and limited by the
small number of studies and their low levels of evidence.
Conclusions
BTI is already widely used as an early treatment for this age group. The safety profile
of BTI in infants appears similar to that of older children and risks appear more
related to the severity of the pathology and the location of the injections than to
the toxin itself. Regarding effectiveness, other studies with higher levels of evidence
should be carried out for each specific pathology.
Keywords
List of abbreviations:
BTI (Botulinum toxin injection), CP (Cerebral palsy), CT (Congenital torticollis), OBPP (Obstetric brachial plexus palsy), PEDro (Physiotherapy Evidence Database), RCT (Randomized controlled trial)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 26, 2017
Footnotes
Disclosures: Brochard has a financial relation with Allergan outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
