Use of botulinum toxin A in children with cerebral palsy

BACKGROUND: For more than 20 years, intramuscular injections of botulinum toxin A have been an established treatment for spasticity in children with cerebral palsy. We investigated the proportion of children with cerebral palsy who receive such treatment in Norway and the guidelines that apply to the treatment. MATERIAL AND METHOD: Data from the five-year registration in the Cerebral Palsy Registry of Norway were used to investigate the proportion of children with cerebral palsy born in the period 1999-2010 treated with botulinum toxin A, and whether there were any variations in the proportion of children treated between the habilitation centres. We conducted an online survey to identify the treatment guidelines that were applied in all of the 21 habilitation centres. RESULTS: A total of 1 414 children (average age 6.3 years) were included, of whom 775 (55 %) had been treated with botulinum toxin A. The proportion of children who received treatment varied considerably between the habilitation centres (38-80 %; p < 0.001). The maximum dose of botulinum toxin A per treatment per patient was 200-600 units of Botox. Five centres reported to have written guidelines for the treatment indication. INTERPRETATION: The proportion of children with cerebral palsy who are treated with botulinum toxin A varies considerably between Norwegian habilitation centres.