Document Type

Critically Appraised Topic

Publication Date

2011

Clinical Scenario

Cerebral palsy (CP) is a disorder of movement, muscle tone or posture that is caused by injury or abnormal development in the immature brain, most often before birth (Mayo Clinic staff, 2011). In the United States 3.3 per 1000 8-year old children have cerebral palsy, the leading cause of motor impairments in children (CDC, 2011). Currently there are approximately 500,000 children in the United States who have cerebral palsy and an additional 10,000 children are born with cerebral palsy each year (My Child, 2011). There are three types of cerebral palsy: spastic, athetoid, and ataxic. Spastic cerebral palsy is the most common form, accounting for approximately 70% of all cases (emedicine.com, 2011). Symptoms of spastic CP include muscle weakness, loss of movement, tight muscles, abnormal gait patterns, and joint contractures. Symptoms may affect one or both sides of the body (Medlineplus, 2011).

Current treatments for children with spastic cerebral palsy include occupational and physical therapy, speech and language therapy, serial casting, orthotic devices, oral medications, intrathecal baclofen and botulinum toxin injections. Beginning in the 1990s, botulinum toxin injections (BTX-A) have been used to treat spastic muscles associated with cerebral palsy (NINDS, 2011). BTX-A injections chemically denervate spastic or hypertonic muscles by inhibiting acetylcholine release from the terminal junction resulting in a temporary reduction in tone (Wallen et al, 2007). Botox is a brand of botulinum toxin commonly used for injections.

This treatment is not FDA approved, and limited research has been completed on this treatment method, especially with children. According to Botox™ the safety of this treatment has not yet been established for the purpose of treating spasticity in pediatric patients (Allergan, 2011). It is still unclear how BTX-A injections influence body structures and neurological process in the long-term (Barrett, 2011). Are the long-term effects worth the short-term benefits?

Clinical Question

What are the long-term effects of Botox treatment on upper extremity in pediatric clients who have Cerebral Palsy?

Clinical Bottom Line

Results from the reviewed research indicate short-term benefits of BTX-A injections in addition to occupational therapy for the purpose of decreasing spasticity and increasing function of the upper extremity in children with cerebral palsy. There is a limited amount of research on this topic, specifically examining longer-term effects of BTX-A injection treatments. All studies reviewed in this paper found that significant differences between groups disappeared after 6 months, suggesting that occupational therapy provides the same health benefits in the long-term without the use of BTX-A injections. No research was located examining effects of injections for a longer duration. This intervention method must be administered by a well trained physician, can be very expensive and the safety of this treatment has yet to be determined for its use with children.

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