Patient satisfaction with flexible botulinum toxin injection intervals: Preliminary results of a telephone survey (original) (raw)

Introduction and objectives: Cerebral palsy (CP) is the most common cause of chronic disability in childhood and may lead to cognitive delay and difficulty in walking. Botulinum toxin type A is a well-established treatment for spasticity in patients with CP. In this retrospective case series, we report our experience of incobotulinumtoxinA (Xeomin) treatment for children with CP. Methods: Sixty-nine patients with CP (63.8% male) received 191 incobo-tulinumtoxinA injections, frequently under sedation or anesthesia. Doses, treatment intervals, muscles injected, and tolerability were recorded. Results: Children's mean (standard deviation; SD) age was 8.3 (4.0) years; mean weight was 25.5 (SD, 13.5) kg; and mean time since starting treatment was 10.6 (SD, 9.4) months. The Gross Motor Function Classification System level was I for 15% of patients, II for 41%, III for 7%, IV for 15%, and V for 22%; 39.1% of patients were hemiplegic, 23.2% diplegic, and 37.3% tetraplegic. Patients received a mean (SD) of 2.8 (1.5) incobotulinumtoxinA treatments at mean (SD) intervals of 6.0 (1.7) months. From the first to the sixth treatment, the mean (SD) total dose increased from 191.7 (126.2) U (8.5 [5.4] U/kg weight) to 368.0 (170.1) U (9.9 [5.5] U/kg weight), and the mean (SD) number of muscles injected increased from 2.4 (1.2) to 4.2 (1.9). The most frequently injected muscles were gastrocnemius (68.1% of patients), hamstrings (47.8%), adductor longus (42.0%), finger flexors (18.8%), adductor magnus (18.8%), and biceps brachii (13.0%). Five adverse effects were reported (7.2% of patients, 2.6% of injections); 3 of these occurred during the first treatment. Adverse events assessed as treatment related were muscle weakness, generalized weakness, and fever. Conclusions: IncobotulinumtoxinA is well tolerated in the treatment of focal spasticity in children with CP.