Botulinum toxin and Gross Motor Function Classification System: a 17-year Retrospective Study on Target Muscles and Doses
DOI :
https://doi.org/10.25759/spmfr.566Mots-clés :
Pediatric Rehabilitation, Botulinum Toxin, Neurotoxin, Spasticity, Cerebral Palsy, Gross Motor Function Classification SystemRésumé
Background: Botulinum toxin type A (BoNT-A) is widely used to manage focal spasticity in children with cerebral palsy (CP), the leading cause of spasticity in childhood. Injections aim to improve function, gait, positioning, hygiene, appearance, and pain control.
Objectives: This single-center retrospective study analyzed the use of anobotulinumtoxinA and abobotulinumtoxinA in children with CP, using each injection session as the unit of analysis. We examined the relationship between Gross Motor Function Classification System (GMFCS) levels and the muscles targeted, and secondarily described demographics, doses, and adverse reactions.
Methods: All injection sessions performed between 2007 and 2023 in patients under 19 years old were reviewed. Ambulatory children were defined as those walking independently or with walking aids (GMFCS ≤ III), while nonambulatory children required a wheelchair for mobility (GMFCS > III). Duplicate records were removed prior to analysis. Between-group comparisons were performed using the Mann-Whitney U test(IBM SPSS v.28). Statistical significance was set at p< 0.05 with effects reported using 95% confidence intervals.
Results: A total of 883 BoNT-A injection sessions were analyzed in 163 children (median age 8.2 IQR 5.1-12.3). OnabotulinumtoxinA (627 sessions) and abobotulinumtoxinA (256 sessions) were administered at mean doses of 187 IU (95% CI 179-194) and 564 IU (95% CI 544-586). Doses were significantly higher in non-ambulatory children for both total and weight-adjusted values (p< 0.001). The most frequently injected muscles in non-ambulatory children were the adductors and hamstrings, while ambulatory children more often received injections in the gastrocnemius, soleus, and tibialis posterior. No severe adverse events were reported.
Conclusions: BoNT-A is a safe and effective treatment for pediatric spasticity across all GMFCS levels. Adapting muscle selection and dosing according to functional level optimizes therapeutic outcomes and helps prevent deformities. Clinically, this supports individualized toxin protocols integrated into long-term rehabilitation programs. The main limitation is the retrospective, single-center design, which may restrict generalizability.
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