Current Australian clinical practice in use of botulinum toxin-A to manage paediatric hypertonicity

Journal article


O'Flaherty, Stephen J and Stewart, Kirsty. (2021). Current Australian clinical practice in use of botulinum toxin-A to manage paediatric hypertonicity. Journal of Paediatrics and Child Health. 57(10), pp. 1662-1665. https://doi.org/10.1111/jpc.15589
AuthorsO'Flaherty, Stephen J and Stewart, Kirsty
Abstract

Aim
To describe current rehabilitation paediatricians' use of intramuscular botulinum toxin-A (BoNT-A) to manage hypertonicity.

Methods
Cross-sectional survey.

Results
In late 2019, 32 of the 35 identified Australian rehabilitation paediatricians who use BoNT-A to manage paediatric hypertonicity completed the survey. Annually, they administer just over 3750 courses of BoNT-A to manage hypertonicity with a mean of 11 years of clinical experience. Sedation was used by all but 1 clinician who used a number of other strategies during the procedure. Mean (and median) maximum dose of OnabotulinumtoxinA (Botox) was 400 Units (range 300–450 Units). Only three clinicians indicated that they used AbobotulinumtoxinA (Dysport) – the other BoNT-A preparation approved for children available in Australia; analysis of its use was not performed. Dose modifications were made by clinicians according to a patient's response to a previous course of BoNT-A (88% of respondents); patient experience of a previous adverse event (78%); history of aspiration or dysphagia (65 and 63%, respectively); and the presence of dystonia; and where the patient was GMFCS level V (53% each). Intervals between courses ranged from 3 to 24 months with the variation due to clinical circumstances.

Conclusion
Clinical practice in BoNT-A management of paediatric hypertonicity was largely consistent in regard to maximum doses of OnabotulinumtoxinA (Botox) used. Dose modification and time between injection courses varied according to individual clinical presentation. Procedural sedation was used extensively.

Keywordsbotulinum toxin-A; hypertonicity; paediatric
Year2021
JournalJournal of Paediatrics and Child Health
Journal of Paediatrics and Child Health
Journal citation57 (10), pp. 1662-1665
PublisherBlackwell Publishing
ISSN1034-4810
Digital Object Identifier (DOI)https://doi.org/10.1111/jpc.15589
PubMed ID34036660
Scopus EID2-s2.0-85106417529
Research or scholarlyResearch
Page range1662-1665
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online23 May 2021
Publication process dates
Accepted16 May 2021
Deposited09 Nov 2021
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