BOTULINUM TOXIN A (BTX-A) INJECTION USE IN CHILDREN WITH CEREBRAL PALSY (CP) IN AOTEAROA NEW ZEALAND: A NATIONAL LOOK

Introduction BTX-A has been used in the management of spasticity in CP for >25 years in NZ and is provided by different specialists in centres across NZ. The aims of this study were to (1) describe use of BTX-A interventions for children with CP across NZ at a population level; (2) explore inequities of access. Methods Data from the NZ Cerebral Palsy Register, matched with Ministry of Health data were analysed by GMFCS level, CP type, ethnicity, NZ Deprivation Index, and region. Analysis included 1,149 children across NZ. Results By age 15, 725 children (63%) had ≥1 episodes of BTX-A injections (total: 3,732 episodes). By regression modelling, for GMFCS levels, compared to GMFCS I the odds of having any BTX-A were all increased in levels II- IV, with a peak at level III (OR: GMFCS II 3.05; III 5.41; IV 4.85). When adjusted by GMFCS levels, those with a diagnosis of triplegia or quadriplegia, were less likely to have BTX-A than those with hemiplegia or diplegia (OR: 0.38). Compared to Starship, other regions had a 25-35% lower chance of repeat injection episodes. However, region did not affect age at first treatment. Socioeconomic status and ethnicity were not statistically associated with odds of BTX-A treatment, age at first treatment, or treatment frequency. Discussion/Conclusions Two in three children with CP had BTX-A injections in childhood; these children were more likely to be GMFCS levels III and IV and classified as hemiplegia / diplegia. The region of service showed the largest degree of variation in the delivery of repeat injections, with Starship delivering greater number of repeat episodes compared to other centres in NZ. Inequities related to socio-economic status and ethnicity were not seen.