Article

We studied the incidence of incontinence and respiratory events in children
with cerebral palsy who received injections of botulinum toxin A (BoNT-A).
METHOD: We used multivariable logistic regression to investigate relationships
between (BoNT-A) dose, Gross Motor Function Classification System (GMFCS) level,
and the incidence of bladder or bowel incontinence, unplanned hospital admission,
emergency department consultation or prescription of antibiotics for respiratory
symptoms, and diagnosis of upper respiratory tract infection. RESULTS: Of 1980
injection episodes in 1147 children (mean age 4y 7mo, SD 1y 10mo, range 9mo-23y),
488 (25%) were in children with unilateral involvement and 1492 (75%) in children
with bilateral involvement. At the time of injection 440 (22.2%) of children were
at GMFCS level I, 611 (30.9%) were at level II, 330 (16.7%) were at level III,
349 (17.6%) were at level IV, and 250 (12.6%) were at level V. The incidence of
serious adverse events was low, with 19 episodes of incontinence (1% of injection
episodes) and 25 unplanned hospital admissions due to respiratory symptoms
(1.3%). Incontinence typically resolved spontaneously 1 to 6 weeks after
injection. The incidence of adverse events was associated with GMFCS level and
dose of BoNT-A. INTERPRETATION: The incidence of serious adverse events was low
but suggests systemic spread as well as a procedural effect. We recommend
reviewing upper dose limits for children at all GMFCS levels, particularly those
at levels IV and V with a history of aspiration and respiratory disease. In these
children, alternatives to mask anaesthesia may be particularly important.

Langue : ANGLAIS