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Journal of Child Neurology, Vol. 22, No. 1, 116-122 (2007)
DOI: 10.1177/0883073807299975

Botulinum Toxin Type B Improves the Speed of Reaching in Children With Cerebral Palsy and Arm Dystonia: An Open-Label, Dose-Escalation Pilot Study

Terence D. Sanger, MD, PhD

Division of Child Neurology and Movement Disorders, Stanford University Medical Center, Stanford, California, sanger{at}stanford.edu

Sahana N. Kukke, MS

Division of Child Neurology and Movement Disorders, Stanford University Medical Center, Stanford, California

Sara Sherman-Levine, PNP

Division of Child Neurology and Movement Disorders, Stanford University Medical Center, Stanford, California

Seven children between 2 and 15 years of age with cerebral palsy and upper extremity dystonia were enrolled in an open-label, dose-escalation pilot clinical trial of botulinum toxin type B (Myobloc), injected into the biceps and brachioradialis muscles of 1 or both arms. The primary outcome measure was the change in maximum speed of hand movement during attempted forward reaching. Escalating doses of 12.5, 25, and 50 U/kg per muscle were injected at each of 3 visits. Reaching speed improved in response to injection, and dystonia scores on the Burke-Fahn-Marsden dystonia scale, the Unified Dystonia Rating Scale, and the Unified Parkinson's Disease Rating Scale improved. There was not a dose-related effect on efficacy. There were no serious adverse events. Two children reported transient weakness. These results support the use of botulinum toxin type B as a safe and effective treatment for upper extremity dystonia in children with cerebral palsy. Larger controlled trials are needed to confirm these results.

Key Words: botulinum toxin • dystonia • cerebral palsy


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