Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy

The efficacy of repeated botulinum toxin A (BTX‐A) injections in two and three dose regimes, together with occupational therapy, on upper limb movement and function, was studied using an evaluator blinded, randomized, controlled two‐group trial. Forty‐two children (31 males, 11 females; range 2–8y, mean 4y [SD 1y 7mo]) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) longitudinally participated for 30 months, with the first 6 months reported earlier (Lowe et al. 2006). The BTX‐A group ( n =21) received three injections (0, 6, and 18mo), while the delayed group had two (6 and 18mo; dose 0.5‐2.1 units/kg, mean 1.5 [SD 0.18]; dilution 100 units/0.5ml). At 30 months, no difference existed between groups on any standardized measures. First and second injections showed significant treatment effect sizes, on Quality of Upper Extremity Skills Test (5.5 p =0.01: 4.5 p =0.03); parent Goal Attainment Scaling (GAS; 3.5 p =0.02: 3.9 p =0.01; therapist GAS 7.8 p =0.00: 4.0 p =0.03); Canadian Occupational Performance Measure (performance 0.4 p =0.05: 0.4 p =0.02; satisfaction 0.4 p =0.05: 0.37 p =0.08); and Pediatric Evaluation of Disability Inventory functional skills (1.8 p =0.00: 2.3 p =0.04). BTX‐A was not linked to adverse events, suggesting repeated upper limb injections in children with hemiplegia receiving occupational therapy were safe and effective for improvement of movement and function.