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Effectiveness of botulinum toxin injection on upper-limb motor function of children with OBPP
Annals of Physical and Rehabilitation Medicine 60S (2017) e61–e63
Available online at
ScienceDirect www.sciencedirect.com
Pediatric PMR
CO195
CO196
Effectiveness of botulinum toxin injection on upper-limb motor function of children with OBPP
Safety and effectiveness of botulinum toxin injection in children younger than 2 years old: A systematic review
Sylvain Brochard 1,∗ , Nathaly Quintero 2 , Tanguy Le Corre 1 , Franck Fitoussi 3 , Claudia Romana 3 , Christelle Pons 1 1 CHU Morvan, MPR, Brest, France 2 Hôpitaux de Saint-Maurice, MPR, Saint-Maurice, France 3 Hôpital Trousseau, chirurgie orthopédique pédiatrique, Paris, France ∗ Corresponding author. E-mail address: [email protected] (S. Brochard)
Sylvain Brochard 1,∗ , Anais Molina 2 , Jean-Sébastien Bourseul 1 , Mael Lintanf 1 , Laëtitia Houx 1 , Emmanuelle Chaleat-Valayer 3 , Christelle Pons 1 1 CHRU Morvan, MPR, Brest, France 2 CHRU Charles-Nicolle, MPR, Rouen, France 3 Croix-Rouge franc¸aise, centre médico-chirugical et de réadaptation des Massues, Lyon, France ∗ Corresponding author. Adresse e-mail : [email protected] (S. Brochard)
Objective Obstetrical brachial plexus palsy (OBPP) is often complicated by contractures of shoulder internal rotators and/or co-contractions of the biceps/triceps brachii muscles. They are responsible of early limitations of the upper limb movements and thus limit children at the activity and participation level. The aim of this study was to evaluate the effect of botulinum toxin injections (BTI) on the active movements of the upper limb. Material/patients and methods Eighty-three children with C5-C7 injury received BTI with an average age of 4.2 years (ET: 55 months): 39 children in the intern rotators (IR), 44 in the triceps brachii (TB). The primary outcome measure was the Mallet scale at baseline, 3 months followed by a measure at 6 months of ITB. Comparisons using paired t-test were used to assess the statistical significance of the between-group differences. Sub-group analysis on different variables were carried out (age, gender, Mallet sub-score. . .). Results For the RI group, the total Mallet score increased significantly at 3 months (+4.3 on average out of a maximum score of 25) and remained significantly greater at 6 months (+2.6) compared to baseline with a greater improvement on the abduction task. For the TB group, the total Mallet score increased significantly at 3 months (+3.8) and remained significantly greater at 6 months (+2.6) compared to baseline with a greater improvement during the hand to mouth task. Discussion – conclusion This study suggests that ITB is likely to improve the motor function of the upper limb of children with OBPP as it has been previously suggested in studies involving smaller groups. It also suggests a specific functional effect depending on the site of the injections and a prolonged effect until 6 months. Randomized controlled trials are needed to definitely confirm these preliminary results. Keywords Obstetrical brachial plexus palsy; Botulinum toxin; Mallet scale; Motor function of the upper limb; Shoulder; Elbow Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.106 1877-0657/
Objective Botulinum toxin injection is increasingly used in children with musculoskeletal disorders. The literature supports the hypothesis that the earlier the injection is carried out the better the efficiency is. The aim of this study was to systematically review the literature reporting on the safety and effectiveness of botulinum toxin injection in infants (younger than 2 years old). Material/patients and methods From 947 articles extracted from 5 database, seventeen articles including data available for children younger than 2 years was included in the systematic review (11 articles included specifically children younger than 2 years). Results Data from 482 infants with cerebral palsy (n = 64), brachial plexus palsy (n = 112), clubfoot (n = 257), congenital torticollis (n = 44) were analyzed. Adverse effects did not appear to be more severe or more frequent than in older children. The risks were not related to the age but more to the severity of the disability and associated impairments. The first studies exhibiting an effectiveness of the botulinum toxin injections were of low grade of evidence (2 RCTs). There were scarce descriptions of the injection protocol. Recommendations based on the lowest age and highest doses reported are made according to the different pathologies for clinical practice. Discussion – conclusion In 482 infants with various musculoskeletal disorders, botulinum injection toxin injection does not present specificities in term of safety compared to older children. More randomized control trials are needed to assess the efficacy of early botulinum injection in infants with musculoskeletal disorders. Keywords Botulinum toxin; Infant; Safety; Early; Effectiveness Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.107
Available online at
ScienceDirect www.sciencedirect.com
Pediatric PMR
CO195
CO196
Effectiveness of botulinum toxin injection on upper-limb motor function of children with OBPP
Safety and effectiveness of botulinum toxin injection in children younger than 2 years old: A systematic review
Sylvain Brochard 1,∗ , Nathaly Quintero 2 , Tanguy Le Corre 1 , Franck Fitoussi 3 , Claudia Romana 3 , Christelle Pons 1 1 CHU Morvan, MPR, Brest, France 2 Hôpitaux de Saint-Maurice, MPR, Saint-Maurice, France 3 Hôpital Trousseau, chirurgie orthopédique pédiatrique, Paris, France ∗ Corresponding author. E-mail address: [email protected] (S. Brochard)
Sylvain Brochard 1,∗ , Anais Molina 2 , Jean-Sébastien Bourseul 1 , Mael Lintanf 1 , Laëtitia Houx 1 , Emmanuelle Chaleat-Valayer 3 , Christelle Pons 1 1 CHRU Morvan, MPR, Brest, France 2 CHRU Charles-Nicolle, MPR, Rouen, France 3 Croix-Rouge franc¸aise, centre médico-chirugical et de réadaptation des Massues, Lyon, France ∗ Corresponding author. Adresse e-mail : [email protected] (S. Brochard)
Objective Obstetrical brachial plexus palsy (OBPP) is often complicated by contractures of shoulder internal rotators and/or co-contractions of the biceps/triceps brachii muscles. They are responsible of early limitations of the upper limb movements and thus limit children at the activity and participation level. The aim of this study was to evaluate the effect of botulinum toxin injections (BTI) on the active movements of the upper limb. Material/patients and methods Eighty-three children with C5-C7 injury received BTI with an average age of 4.2 years (ET: 55 months): 39 children in the intern rotators (IR), 44 in the triceps brachii (TB). The primary outcome measure was the Mallet scale at baseline, 3 months followed by a measure at 6 months of ITB. Comparisons using paired t-test were used to assess the statistical significance of the between-group differences. Sub-group analysis on different variables were carried out (age, gender, Mallet sub-score. . .). Results For the RI group, the total Mallet score increased significantly at 3 months (+4.3 on average out of a maximum score of 25) and remained significantly greater at 6 months (+2.6) compared to baseline with a greater improvement on the abduction task. For the TB group, the total Mallet score increased significantly at 3 months (+3.8) and remained significantly greater at 6 months (+2.6) compared to baseline with a greater improvement during the hand to mouth task. Discussion – conclusion This study suggests that ITB is likely to improve the motor function of the upper limb of children with OBPP as it has been previously suggested in studies involving smaller groups. It also suggests a specific functional effect depending on the site of the injections and a prolonged effect until 6 months. Randomized controlled trials are needed to definitely confirm these preliminary results. Keywords Obstetrical brachial plexus palsy; Botulinum toxin; Mallet scale; Motor function of the upper limb; Shoulder; Elbow Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.106 1877-0657/
Objective Botulinum toxin injection is increasingly used in children with musculoskeletal disorders. The literature supports the hypothesis that the earlier the injection is carried out the better the efficiency is. The aim of this study was to systematically review the literature reporting on the safety and effectiveness of botulinum toxin injection in infants (younger than 2 years old). Material/patients and methods From 947 articles extracted from 5 database, seventeen articles including data available for children younger than 2 years was included in the systematic review (11 articles included specifically children younger than 2 years). Results Data from 482 infants with cerebral palsy (n = 64), brachial plexus palsy (n = 112), clubfoot (n = 257), congenital torticollis (n = 44) were analyzed. Adverse effects did not appear to be more severe or more frequent than in older children. The risks were not related to the age but more to the severity of the disability and associated impairments. The first studies exhibiting an effectiveness of the botulinum toxin injections were of low grade of evidence (2 RCTs). There were scarce descriptions of the injection protocol. Recommendations based on the lowest age and highest doses reported are made according to the different pathologies for clinical practice. Discussion – conclusion In 482 infants with various musculoskeletal disorders, botulinum injection toxin injection does not present specificities in term of safety compared to older children. More randomized control trials are needed to assess the efficacy of early botulinum injection in infants with musculoskeletal disorders. Keywords Botulinum toxin; Infant; Safety; Early; Effectiveness Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.107