Article

Previous studies have shown the efficacy of botulinum toxin type A (BoNT-A)
in the management of ambulant individuals with cerebral palsy (CP). There is
little evidence on its use in non-ambulant children with CP.
This review aimed to
investigate indications and efficacy for BoNT-A use in managing pain, care, and
comfort, and improving function in children with CP in Gross Motor Function
Classification System (GMFCS) levels IV and V. METHOD: Electronic databases were
searched from the earliest available date to June 2012 using a combination of
subject headings and free text. Inclusion criteria consisted of studies with (1)
participants aged 18 or under, (2) participants with CP in GMFCS levels IV and V,
(3) participants receiving BoNT-A treatment, and (4) studies published in
English-language peer-reviewed journals. RESULTS: The search resulted in a total
of 814 studies, of which 19 met the inclusion criteria. Eighteen studies provided
level IV or V evidence and one level I evidence according to the American Academy
for Cerebral Palsy and Developmental Medicine guidelines for the development of
systematic reviews. Most of the studies were of weak to moderate methodological
quality. INTERPRETATION: The evidence that BoNT-A is effective in reducing
postoperative pain in children with CP in GMCFS levels IV and V is limited, with
only one level I study identified. Remaining indications were general pain
reduction, maintaining hip integrity, achieving functional changes, and goal
attainment. A high percentage of participants in the studies showed positive
changes in these areas. With the poor level of evidence of the included studies,
no definite conclusion could be drawn on the indications for BoNT-A use in
children with CP in GMCFS levels IV and V. Further investigation by rigorous
studies is required.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS