Early Botulinum Toxin Injections in Infants with Musculoskeletal Disorders: A Systematic Review of Safety and Effectiveness.

Publication date: Available online 27 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jean-Sébastien Bourseul, Anais Molina, Mael Lintanf, Laetitia Houx, Emmanuelle Chaléat-Valayer, Christelle Pons, Sylvain Brochard
ObjectiveTo report current evidence regarding the safety of intramuscular BTI in children with orthopaedic- and neurological-related musculoskeletal disorders under the age of 2 years.Data SourcePUBMED, The Cochrane Library, and Science Direct, Google Scholar and Web of Science.Study SelectionTwo reviewers independently selected studies based on predetermined inclusion criteria.Data ExtractionData relating to the aim were extracted. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for nonRCTs. Level of evidence was determined using the modified Sackett scale.Data SynthesisData of 473 infants were analysed. Fifty-five infants had cerebral palsy, 112 had obstetric brachial plexus palsy, 257 had clubfoot and 44 had congenital torticollis. No studies reported any severe adverse event that could be attributed to the BTI. The rate of mild to moderate adverse events reported varied from 5 to 25%. Results regarding efficacy were preliminary, dependant on the pathology and limited by the small number of studies and their low levels of evidence.ConclusionBTI is already widely used as an early treatment for this age group. The safety profile of BTI in infants appears similar to that of older children and risks appear more related to the severity of the pathology and the location of the injections than to the toxin itself. With regard to effectiveness, other studies with higher levels of evidence should be carried out for each specific pathology.



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