Severity of cerebral palsy and likelihood of adverse events after botulinum toxin A injections

• Published in: Developmental medicine and child neurology 2018-05, Vol.60 (5), p.498-504
• Main Authors: Swinney, Caitlyn M, Bau, Karen, Burton, Karen L Oakley, O'Flaherty, Stephen J, Bear, Natasha L, Paget, Simon P
• Format: Article
• Language: English
• ISSN: 0012-1622; 1469-8749
• DOI: 10.1111/dmcn.13686

Aim To determine the incidence of common adverse events after botulinum toxin A (BoNT‐A) injections in children with cerebral palsy (CP) and to identify whether the severity of CP influences the incidence of adverse events. Method This was an observational study of patients attending a BoNT‐A clinic at a tertiary paediatric hospital (2010–2014). Data examined included procedural adverse events at the time of injection and at follow‐up. Systemic adverse events were defined as lower respiratory tract illnesses, generalized weakness, dysphagia, and death. Severity of CP was categorized by the Gross Motor Function Classification System (GMFCS). The relationships between GMFCS and adverse events were analysed using negative binomial regression models. Results In total, 591 children underwent 2219 injection episodes. Adverse events were reported during the procedure (130 [6%] injection episodes) and at follow‐up (492 [22%] injection episodes). There were significantly increased rates of systemic adverse events in injection episodes involving children in GMFCS level IV (incidence rate ratio [IRR] 3.92 [95% confidence interval] 1.45–10.57]) and GMFCS level V (IRR 7.37 [95% confidence interval 2.90–18.73]; p