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Dimitrova R, Kim H, Meilahn J, Chambers HG, Racette BA, Bonikowski M, Park ES, McCusker E, Liu C, Brin MF. Efficacy and safety of onabotulinumtoxinA with standardized physiotherapy for the treatment of pediatric lower limb spasticity: A randomized, placebo-controlled, phase III clinical trial. NeuroRehabilitation 2021; 50:33-46. [PMID: 34957954 PMCID: PMC8925123 DOI: 10.3233/nre-210070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Spasticity is common in cerebral palsy and can result in pain and diminished health-related quality of life. OBJECTIVE: To evaluate the safety and efficacy of onabotulinumtoxinA for lower limb spasticity treatment in children with cerebral palsy. METHODS: In this registrational phase 3, multinational, randomized, double-blind, placebo-controlled trial (NCT01603628), children (2–< 17 years) with cerebral palsy and ankle spasticity (Modified Ashworth Scale-Bohannon [MAS] score≥2) were randomized 1 : 1 : 1 to standardized physical therapy and onabotulinumtoxinA (4 or 8 U/kg), or placebo. Primary endpoint was average change from baseline at weeks 4 and 6 in MAS ankle score. Secondary endpoints included the Modified Tardieu Scale (MTS) and Global Attainment Scale (GAS). RESULTS: 381 participants were randomized. MAS scores averaged at weeks 4 and 6 were significantly reduced with both onabotulinumtoxinA doses (8 U/kg: –1.06, p = 0.010; 4 U/kg: –1.01, p = 0.033) versus placebo (–0.8). Significant improvements in average dynamic component of spasticity, measured by MTS, and in function, measured by GAS, were observed at several time points with both onabotulinumtoxinA doses versus placebo. Most adverse events were mild or moderate. CONCLUSIONS: OnabotulinumtoxinA was well tolerated and effective in reducing lower limb spasticity and improving functional outcomes versus placebo in children.
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Affiliation(s)
| | - Heakyung Kim
- Columbia University Medical Center, New York, NY, USA
| | - Jill Meilahn
- Marshfield Clinic Health System, Marshfield, WI, USA
| | | | - Brad A Racette
- Washington University School of Medicine, St. Louis, MO, USA.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, SouthAfrica
| | | | | | | | | | - Mitchell F Brin
- Allergan, an AbbVie company, Irvine, CA, USA.,University of California, Irvine, CA, USA
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Withers JW, Muzzolon SB, Zonta MB. Influence of adapted hip-hop dancing on quality of life and social participation among children/adolescents with cerebral palsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:712-722. [PMID: 31664347 DOI: 10.1590/0004-282x20190124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 07/21/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the influence of adapted hip-hop dancing on the quality of life (QoL) and biopsychosocial profile of children/adolescents with cerebral palsy (CP). METHODS Pilot study including 18 children/adolescents with CP and Gross Motor Function Classification System levels I and II. Nine participants took part in an adapted hip-hop dance practice (study group; SG), and nine others served as the control group (CG). All participants were assessed with the Pediatric Outcomes Data Collection Instrument and the Child Behavior Checklist at baseline and after at least three months of dance practice and a public performance (SG) or a similar period without intervention (CG). RESULTS Improvement in QoL was observed in the SG in the domains of transfer and basic mobility (p = 0.00*), sporting and physical function (p = 0.04*), and global function and symptoms (p = 0.01*). In the SG, there was a reduction in emotional and behavioral problems and an increase in social competence in the biopsychosocial profile. Greater participation in adapted hip-hop dancing was associated with a greater gain in the transfer and basic mobility domains (p = 0.05*) of the Pediatric Outcomes Data Collection Instrument and in the activities (p = 0.05*) and social (p = 0.04*) scales of the Child Behavior Checklist. CONCLUSIONS Children/adolescents with CP participating in adapted hip-hop dance practice showed improvement in QoL and biopsychosocial profile scores.
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Affiliation(s)
- Joseana Wendling Withers
- Universidade Federal do Paraná, Setor de Ciências da Saúde, Pós-graduação em Saúde da Criança e do Adolescente, Curitiba PR, Brasil
| | - Sandra Baggio Muzzolon
- Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Psicologia, Curitiba PR, Brasil
| | - Marise Bueno Zonta
- Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Reabilitação, Curitiba PR, Brasil
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Rumore MM. Medication Repurposing in Pediatric Patients: Teaching Old Drugs New Tricks. J Pediatr Pharmacol Ther 2016; 21:36-53. [PMID: 26997928 PMCID: PMC4778695 DOI: 10.5863/1551-6776-21.1.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Gaps in pediatric therapeutics often result in off-label use and specifically, novel uses for existing medications, termed "drug repurposing." Drug Information (DI) queries to a Pediatric Medication Resource Center of a large metropolitan pediatric hospital in New York and inherent difficulties in retrieving evidence-based information prompted a review of current medication repurposing for pediatric patients. The objective included characterization of innovative off-label use of medications Food and Drug Administration (FDA)-approved for 1 or more indications to treat a totally different disorder or indication in pediatric patients. METHODS A systematic literature review was conducted to retrieve publications describing repurposed medications in pediatric patients. Excluded was FDA-approved indications used off-label in pediatric patients (e.g., different dose), preclinical data, adult use only, and experimental use. Evidence quality was classified using a modified American Academy of Neurology Level of Evidence. Results were analyzed using χ(2) at p < 0.05. RESULTS Over 2000 references were retrieved and reviewed. A total of 101 medications repurposed for novel off-label uses for pediatric patients were identified: 38 for neonates, 74 for children, and 52 for adolescents. Neonates and infants were least likely to receive a medication for a repurposed use. Strong or intermediate evidence existed in 80.2% of cases. The evidence was weak in 19.8%. No significant relationship was observed between the pediatric age group and strength of the literature. Most repurposed uses pertained to generic or widely used medications. Less than 5% of medications were first marketed after 2011. CONCLUSIONS While not exhaustive, the present study represents the most comprehensive listing of novel uses exclusive to pediatric patients. Further research is needed to identify the frequency of repurposed uses. The valuable DI role of pharmacists in assessing repurposed uses is of expanding and increasing importance to ensure such uses are evidence-based.
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Affiliation(s)
- Martha M. Rumore
- Department of Social, Behavioral and Administrative Sciences, Touro College of Pharmacy, New York, New York; Of Counsel, Sorell, Lenna, & Schmidt, LLP, Hauppauge, New York
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Benrhouma H, Yacoubi J, Kraoua I, Klaa H, Ben Youssef-Turki I, Gouider-Khouja N. Place de la toxine botulique dans le traitement de la spasticité de l’enfant. Rev Neurol (Paris) 2014; 170:541-7. [DOI: 10.1016/j.neurol.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/06/2014] [Accepted: 05/07/2014] [Indexed: 11/28/2022]
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Pfeifer LI, Santos TR, Silva DBR, Panúncio Pinto MP, Caldas CA, Santos JLF. Hand function in the play behavior of children with cerebral palsy. Scand J Occup Ther 2014; 21:241-50. [PMID: 24678715 DOI: 10.3109/11038128.2013.871059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of hand function on the occupational performance of playing for children with cerebral palsy. METHODS Twenty children with cerebral palsy took part in the study, of both genders, aged 3-10 years, with motor abilities ranging from I to V and manual abilities from II to IV. Data were collected using the Assessment of Ludic Behaviour before and after botulinum toxin was applied in the upper limbs to reduce spasticity. RESULTS Significant differences were found between the scores before and after the application of botulinum toxin in relation to the total Assessment of Ludic Behaviour score (p < 0.001), as well as in basic ludic interest (p = 0.003), basic ludic ability (p < 0.001), ludic attitude (p = 0.008), and communication of needs and feelings (p = 0.025), except for general level of interest (p = 0.957). CONCLUSIONS The reduction of spasticity permits better handling of the play materials, which promotes the children's involvement in play situations.
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Affiliation(s)
- Luzia Iara Pfeifer
- Department of Neurosciences and Behavioral Sciences, Division of Occupational Therapy , Ribeirão Preto Medical School, University of São Paulo
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Zonta MB, Bruck I, Puppi M, Muzzolon S, Neto ADC, Coutinho dos Santos LH. Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:453-61. [PMID: 23857615 DOI: 10.1590/0004-282x20130061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 03/04/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). METHODS Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory - PEDI), range of movement, gait pattern (Physician Rating Scale - PRS) and the speed of hand movements were considered. RESULTS The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. CONCLUSION Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.
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Affiliation(s)
- Marise Bueno Zonta
- Neuropediatrics Center, Clinics Hospital, Universidade Federal do Paraná (UFPR), Curitiba PR, Brazil.
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Pin TW, Elmasry J, Lewis J. Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review. Dev Med Child Neurol 2013; 55:304-13. [PMID: 23095013 DOI: 10.1111/j.1469-8749.2012.04438.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Previous studies have shown the efficacy of botulinum toxin type A (BoNT-A) in the management of ambulant individuals with cerebral palsy (CP). There is little evidence on its use in non-ambulant children with CP. This review aimed to investigate indications and efficacy for BoNT-A use in managing pain, care, and comfort, and improving function in children with CP in Gross Motor Function Classification System (GMFCS) levels IV and V. METHOD Electronic databases were searched from the earliest available date to June 2012 using a combination of subject headings and free text. Inclusion criteria consisted of studies with (1) participants aged 18 or under, (2) participants with CP in GMFCS levels IV and V, (3) participants receiving BoNT-A treatment, and (4) studies published in English-language peer-reviewed journals. RESULTS The search resulted in a total of 814 studies, of which 19 met the inclusion criteria. Eighteen studies provided level IV or V evidence and one level I evidence according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for the development of systematic reviews. Most of the studies were of weak to moderate methodological quality. INTERPRETATION The evidence that BoNT-A is effective in reducing postoperative pain in children with CP in GMCFS levels IV and V is limited, with only one level I study identified. Remaining indications were general pain reduction, maintaining hip integrity, achieving functional changes, and goal attainment. A high percentage of participants in the studies showed positive changes in these areas. With the poor level of evidence of the included studies, no definite conclusion could be drawn on the indications for BoNT-A use in children with CP in GMCFS levels IV and V. Further investigation by rigorous studies is required.
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Affiliation(s)
- Tamis W Pin
- Kids Rehab Department, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31826b35c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Paralympic medicine describes the health-care issues of those 4500 or so athletes who gather every 4 years to compete in 20 sports at the Summer Paralympic Games and in five sports at the Winter Paralympic Games. Paralympic athletes compete within six impairment groups: amputation or limb deficiencies, cerebral palsy, spinal cord-related disability, visual impairment, intellectual impairment, or a range of physically impairing disorders that do not fall into the other classification categories, known as les autres. The variety of impairments, many of which are severe, fluctuating, or progressive disorders (and are sometimes rare), makes maintenance of health in thousands of Paralympians while they undertake elite competition an unusual demand on health-care resources. The increased physical fitness of athletes with disabilities has important implications for cardiovascular risk reduction in a population for whom the prevalence of risk factors can be high.
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Affiliation(s)
- Nick Webborn
- Centre for Sport Research, Chelsea School of Sport, University of Brighton, Eastbourne, UK.
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