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Journal of Child Neurology, Vol. 21, No. 3, 189-193 (2006)
DOI: 10.2310/7010.2006.00041

Safety of High-Dose Botulinum Toxin Type A Therapy for the Treatment of Pediatric Spasticity

Edward M. Goldstein, MD

Child Neurology Associates, Children's Healthcare of Atlanta at Scottish Rite Children's Medical Center, Marcus Institute Division of Child Neurology, Atlanta, GA, egoldstein@child

This retrospective chart review examines the safety of high-dose (≥ 15 U/kg body weight or ≥ 800 total units) botulinum toxin type A (BOTOX, Allergan Inc., Irvine, CA) in children and young adults with spasticity. Ninety-four children weighing < 45 kg received a mean total dose of 334.1 U or 19.1 U/kg. Fourteen young adults weighing ≥ 45 kg received a mean total dose of 927.3 U or 15.2 U/kg. Adverse events were reported by 3 of the 108 patients (2.8%) and included single instances of rash and enuresis. The only serious adverse event consisted of mild, generalized botulism in a 13-year-old patient who received a 23 U/kg dose to the hamstrings and gastrocnemius/soleus bilaterally. No serious adverse events were noted in children weighing < 45 kg who received botulinum toxin type A doses of 15 to 22 U/kg of body weight or in young adults ≥ 45 kg who received total doses of 800 to 1200 U in a single injection protocol. High-dose botulinum toxin type A is safe for the treatment of spasticity in children and young adults. (J Child Neurol 2006;21:189—192;


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