Botulinum toxin and surgical intervention in children and adolescents with cerebral palsy: who, when and why do we treat?

Introduction: This audit aimed to increase understanding of the long-term outcomes of evidence-based medical and surgical interventions to improve gross motor function in children and adolescents with Cerebral Palsy. Methods: Retrospective audit of a birth cohort (2000–2009) attending a tertiary service in Western Australia. Results: The cohort comprises 771 patients aged 8 to 17 years. Percentage of children receiving no Botulinum Toxin treatments in each Gross Motor Functional Classification System level was: I: 40%, II: 26%, III: 33%, IV: 28% and V: 46%. Of the total cohort, 53% of children received 4 or less Botulinum Toxin treatments and 3.7% received more than 20 treatments. Statistically significant difference in the rate of use of Botulinum Toxin pre and post-surgery (p <0.001) was documented. Children levels IV and V had 5 times the odds of surgery compared to children levels I–III (Odds Ratio 5.2, 95% Confidence Interval 3.5 to 7.8, p <0.001). For 578 (75%) of participants the last recorded level was the same as the first. Conclusion: This audit documents medical intervention by age and Gross Motor Functional Classification System level in a large cohort of children with cerebral palsy over time and confirms stability of the level in the majority.IMPLICATIONS FOR REHABILITATION The information from this audit may be of use in discussions with families regarding the timing and use of Botulinum toxin and surgical intervention for motor function in children and adolescents with Cerebral Palsy. Long term use of Botulinum Toxin within an integrated evidence-based clinical program is not associated with loss of gross motor function in the long term as evidenced by the maintenance of Gross Motor Functional Classification System stability.