Original articleBotulinum toxin type A treatment in children with cerebral palsy: Evaluation of treatment success or failure by means of goal attainment scaling

BackgroundThere is considerable variability in the amount of response to BTX-A treatment between and within patients with cerebral palsy (CP).AimsThe purpose of this retrospective cohort study was to evaluate the clinical responsiveness of Botulinum toxin type A (BTX-A) treatment in children with CP and specifically delineate features of treatment success and failure.MethodsFour hundred and thirty-eight children (251 boys, 187 girls; mean age 8 years 2 months, SD 4 years) were included into the study. Goal Attainment Scaling (GAS) was used to classify and evaluate treatment efficacy. Two study groups were defined: one group with an excellent response (GAS ≥ 60.0) and one group with a lack of response (GAS ≤ 40.0) to BTX-A.ResultsSeventy-five patients (17.1%) had an excellent response and treatment was found to be unsuccessful for 31 patients (7.1%). Children with a lack of response to BTX-A were significantly older compared to children with a high responsiveness (p = 0.0013). In the latter group, more children received multi-level injections and fewer children had injections in proximal parts of the lower limb compared to the low responsiveness group (p = 0.0024). Moreover, there was a significant difference in the use of different types of casts between both study groups (p = 0.0263).ConclusionAge, level of treatment and casting seem to be crucial features of BTX-A treatment success or failure in children with CP.

►This retrospective cohort study quantified responsiveness to BTX-A treatment in CP. ►We specifically delineated features of treatment success and failure. ►Goal Attainment Scaling (GAS) was used to study treatment efficacy in 438 children. ►17.1% had excellent response (GAS ≥ 60) and 7.1% had unsuccessful response (GAS ≤ 40). ►Age, treatment level and casting were crucial features of BTX-A treatment success.