Is botulinum toxin type A more effective and safer than other treatments for the management of lower limb spasticity in children with cerebral palsy? A Cochrane Review summary with commentary.

[BACKGROUND] Botulinum toxin A (BoNT-A) is a well-accepted treatment for the medical management of spasticity in children with cerebral palsy (CP).

[OBJECTIVE] To assess the efficacy and safety of BoNT-A compared with other treatment options in managing lower limb spasticity in children with CP.

[METHODS] A summary of the Cochrane Review update by Blumetti et al. (2019), with comments.

[RESULTS] This review included 31 randomized controlled trials (1508 participants). Compared with usual care/physiotherapy, the evidence is very uncertain about the effect of BoNT-A on gait, function, ankle joint range of motion (ROM), satisfaction, and ankle spasticity in children with CP. Compared with placebo/sham, BoNT-A probably benefits these same outcomes, although the results for function are contradictory. BoNT-A may not be more effective than serial casting at improving gait, function, ankle ROM and spasticity at any time point. However, it may be more effective than an orthosis at medium-term follow-up for hip ROM and adductor spasticity, but not function. The rate of adverse events with BoNT-A is similar to placebo/sham and serial casting.

[CONCLUSIONS] Evidence for the effectiveness and safety of BoNT-A for the management of lower limb spasticity in children with CP is uncertain, with better quality evidence available from studies of placebo/sham than non-placebo controls. To produce high-quality evidence, future studies need to improve their methodological quality and increase sample sizes.