Infiltration with Onabotulinum in children and adolescents with CP and spasticity. A systematic review

Abstract

Background: People with Cerebral Palsy (CP) present functional impair- ments associated with spasticity (85 a 90 %); Botulinum toxin type A (TBA) stands out among the anti-spastic treatments due to its wide clinical use, however, its recommendations for use, dosage, and selection of muscles to infiltrate are varied. Objective: To update and consolidate the knowledge of the use of TBA in patients with CP and spasticity, with respect to therapeutic objectives of use, type of TBA used, recommended dose, dilution, muscles to be infiltrated, assessment guidelines and adjunctive treatments. Material and method: Systematic review of the literature. A search for scientific articles referring to TBA and PC was carried out in the PubMed, Cochrane Library, Embase and Web of Science databases, extracting the information that res­ponded to the objective of the study. Results: There are differences in the recommendations for the use of TBA according to the functional level of the patient with CP, in relation with objectives for use, muscles to be infiltrated, and the optimal dose. The combined use of TBA with rehabilitation therapies is recommended. There is evidence of the safety of the use of TBA in the po- pulation with CP, however, research in animal models shows osteopenia and muscle atrophy due to denervation. Conclusions: TBA therapy is considered a safe and effective treatment to treat spasticity in CP. The decision to treat spasticity with TBA is fundamentally clinical and its use is recommended based mainly on the alteration of functional motor patterns rather than on the evaluation of individual muscles.