National Collaborating Centre for Women's and Children's Health

Spasticity in children and young people with non-progressive brain disorders
Table 7.7 Evidence profile for botulinum toxin type A and physical therapy compared with physical therapy alone;
lower limb; treatment acceptability assessment
Number of
studies
Number of participants Effect Quality
Botulinum
toxin type A
and
occupational
therapy
Occupational
therapy only
Relative
(95% CI)
Absolute
(95% CI)
Parental perception ‘did the parent feel that the botulinum toxin injection had been of benefit to the
child?’ at 3 months
1 study
(Reddihough
2002)
- - - - a Low
Parental perception ‘did the parent feel that the botulinum toxin injection had been of benefit to the
child?’ at 6 months
1 study
(Reddihough
2002)
- - - - b Low
CI confidence interval, P probability
a Statistically significantly more positive responses to the question at 3 months (χ 2 = 12.0, P < 0.05) 95% confidence interval
not calculable. 36 of 47 parents rated the benefit as good, very good or excellent. Of 33 parents who noticed a benefit with
BoNT treatment, 26 reported the maximum benefit occurring within 6 weeks of the injection. The remainder (seven parents)
reported the maximum benefit occurring 6–12 weeks post-injection
b Statistically significantly more positive responses to the question at 6 months (χ 2 =7.16, P < 0.05) 95% confidence interval not
calculable. 35 of 43 parents at 6 months rated the benefit as good, very good or excellent. Of 35 parents who noticed a benefit with
BoNT treatment, 23 reported the maximum benefit occurring within 1–2months of the injection, five reported maximum benefit at 2
to 3 months and the remainder (seven parents) reported the maximum benefit occurring 3 to 6 months post-injection
The Cochrane systematic review (Hoare 2010) and the RCT published after the Cochrane systematic
review (Olesch 2010) relating to treatment of the upper limb reported outcomes relevant to adverse
effects.
Table 7.8 Evidence profile for botulinum toxin type A and physical therapy compared with physical therapy alone;
upper limb; adverse events
Number of
studies
Number of participants Effect Quality
Botulinum
toxin type A
and
occupational
therapy
Occupational
therapy only
Relative
(95% CI)
Absolute
(95% CI)
Adverse effects
1 study (Hoare
2010)
1 study
(Olesch 2010)
- - - - a Low
11 11 - - b Low
CI confidence interval
a 95% confidence interval not calculable. No adverse effects were reported in two studies (Greaves 2005: Speth 2005). No
major adverse events reported in Boyd 2004 although three children were noted to have decreased extension of the index
finger that resolved by 6 weeks. There were 31 adverse events reported by 15 participants and no between-group difference in
Lowe 2006. There were 29 adverse events reported by 20 participants over 6 months in Russo 2007. Three of these events
involved hospitalisation for seizures in known epileptic children, and one child had three hospitalisations for medical reasons.
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