• Lisa Copeland, Priya Edwards, Megan Thorley, Samantha Donaghey, Laura Gascoigne-Pees, Megan Kentish, Grad Cert, Jayne Lindsley, Kim McLennan, Leanne Sakzewski, and Roslyn N Boyd.
• Queensland Cerebral Palsy Health Service, Department of Rehabilitation, Royal Children's Hospital, Brisbane, Australia; Queensland Cerebral Palsy and Rehabilitation Research Center, School of Medicine, The University of Queensland, Brisbane, Australia. Electronic address: Lisa_copeland@health.qld.gov.au.
• J. Pediatr. 2014 Jul 1; 165 (1): 140-146.e4.

ObjectivesTo examine the efficacy and safety of intramuscular botulinum toxin A (BoNT-A) to reduce spasticity and improve comfort and ease of care in nonambulant children with cerebral palsy (CP).Study DesignNonambulant children with CP (n = 41; Gross Motor Function Classification System level IV = 3, level V = 38; mean age 7.1 years, range 2.3-16 years, 66% male) were randomly allocated to receive either intramuscular BoNT-A injections (n = 23) or sham procedure (n = 18) combined with therapy. The analysis used generalized estimating equations with primary outcome the Canadian Occupational Performance Measure (COPM) at 4 weeks postintervention and retention of effects at 16 weeks. Adverse events (AE) were collected at 2, 4, and 16 weeks by a physician masked to group allocation.ResultsThere were significant between group differences favoring the BoNT-A-treated group on COPM performance at 4 weeks (estimated mean difference 2.2, 95% CI 0.8, 3.5; P = .002) and for COPM satisfaction (estimated mean difference 2.2, 95% CI 0.5, 3.9; P = .01). These effects were retained at 16 weeks for COPM satisfaction (estimated mean difference 1.8, 95% CI 0.1, 3.5; P = .04). There were more mild AE at 4 weeks for the BoNT-A group (P = .002), however, there were no significant between-group differences in the reporting of moderate and serious AE.ConclusionsIn a double-blind randomized sham-controlled trial, intramuscular BoNT-A and therapy were effective for improving ease of care and comfort for nonambulant children with CP. There was no increase in moderate and severe AE in the children who had BoNT-A injections compared with the sham group.Crown Copyright © 2014. Published by Mosby, Inc. All rights reserved.

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