Children with CP Tolerate Repeated BtA Injection Sessions without GA
Although controlled data on botulinum toxin type A (BtA) in cerebral palsy (CP) mainly relates to single injection sessions, children with CP on this treatment are likely to receive multiple injections in separate sessions over a number of years. Early researchers used general anaesthetic (GA) to make sessions more acceptable and to ensure accurate placement of injections. Accumulating experience has allowed an increasing proportion of sessions without GA.
We are monitoring the acceptability of injections given three times monthly to children with CP and spasticity taking part in a double blind, parallel group, randomized controlled trial of repeated BtA/placebo injections over 2 years. The children have (1) sedation with oral midazolam 0.5–0.75 mg/kg alone; (2) local anaesthetic cream (EMLA or Ametop) alone; (3) both; or (4) neither. The choice is made at each visit after discussion between parents, researchers, and sometimes, the children. Within 5–10 minutes of BtA/placebo injection, parents are asked to rate the distress caused to their child by the procedure as none, minor, moderate, or major.
After 240 injection sessions in 59 children the responses have been as follows: 21.3% (51) no distress; 57.9% (139) minor distress; 17.9% (43) moderate distress; 2.9% (7) major distress. These results will be discussed in further detail.
In conclusion, it seems acceptable to most children and caregivers for BtA injections to be given without GA, even when repeated sessions are required.