Journal of Pediatric Rehabilitation Medicine - Volume 13, issue 2

Authors: Vova, Joshua A. | Leung, Enoch

Article Type: Article Commentary

Abstract: Botulinum Toxin (BoNT) is widely used to treat hypertonia in pediatric patients. Although serious adverse events (AEs) occur infrequently, they can lead to significant patient morbidity and mortality. This paper will discuss potential safety risks that may affect outcomes, medical comorbidities, medication dosing, targeting techniques, and muscle morphology. It is the responsibility of the physician to discuss risks and benefits regarding the use of BoNT and mitigate risks of AEs while maximizing the effectiveness of the medication.

Keywords: Botulinum Toxin, pediatric rehabilitation, cerebral palsy, hypertonia, spasticity, black box warning, safety

DOI: 10.3233/PRM-200716

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 2, pp. 195-199, 2020

Authors: Davis, Taron

Article Type: Article Commentary

Abstract: Botulinum toxins (BoNT) are a standard of care for spasticity management of children with a variety of neuromuscular (NM) conditions. BoNT relaxes skeletal muscles by inhibiting the release of acetylcholine from the neuromuscular junction (NMJ). As part of their training physiatrist become proficient in the targeted injections of BoNT into affected skeletal musculature. While the pharmacology and pharmacokinetics of BoNT are well characterized, there is limited literature on the clinical impact that varying the volume of diluent that a toxin is reconstituted within. In theory, injection of a larger volume of dilute BoNT would allow for a larger spread affect …reaching more distant NMJs; the reverse is also be true. Dilution volume of BoNT injections in children produces some unique situations due to their low weight, smaller muscle bulk, an increased relative risk of spread to surrounding structures, and novel differences in concentration of NMJ in immature muscle. Some of these factors may act as guiding principles that providers can use when adjusting from their standard BoNT dilutional practices. Although, there are recommended dosing strategies available each child’s spasticity pattern represents a unique situation and providers must be allowed flexibility to think creatively about dilution strategies for BoNT injections. Show more

Keywords: Botulinum toxin, dilution, diffusion, neuromuscular blockade, neuromuscular junction, pediatrics

DOI: 10.3233/PRM-200721

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 2, pp. 201-204, 2020

Authors: Oleszek, Joyce L. | Kanallakan, Amy S. | Powell, Aaron J.

Article Type: Article Commentary

Abstract: Botulinum toxin is frequently used as a therapeutic for a variety of non-FDA approved indications in children. This narrative literature review explores three off-label uses of botulinum toxin in pediatric conditions including congenital muscular torticollis, spastic trismus, and neonatal brachial plexus palsy. While more research is needed to establish treatment, dosing and localization guidelines for the use of botulinum toxin in these commonly treated conditions, available evidence is discussed.

Keywords: Botulinum toxin, torticollis, brachial plexus, trismus

DOI: 10.3233/PRM-200707

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 2, pp. 205-207, 2020

Authors: Rak, Melanie

Article Type: Article Commentary

Keywords: Documentary, disability

DOI: 10.3233/PRM-200725

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 2, pp. 209-210, 2020

Article Type: Other

DOI: 10.3233/PRM-200020

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 2, pp. 211-, 2020

Article Type: Other

DOI: 10.3233/PRM-200021

Citation: Journal of Pediatric Rehabilitation Medicine, vol. 13, no. 2, pp. 213-220, 2020