Individual research recommendation details

Recommendation ID

CG145/3

Question

Botulinum toxin type A:- What is the clinical and cost effectiveness of botulinum toxin type A when used routinely or according to clinical need in children and young people who are at Gross Motor Function Classification System (GMFCS) level I, II or III?

Any explanatory notes
(if applicable)

Why this is important:- The Guideline Development Group's (GDG's) recommendation to consider offering botulinum toxin type A to children and young people with focal spasticity of an upper or lower limb reflected available evidence relating to the safety and effectiveness of botulinum toxin type A. In making their recommendations, the GDG emphasised the importance of establishing individualised goals that justify the use of this potentially harmful toxin to treat spasticity. The cost of the procedure combined with the risk of side effects means that clear treatment goals that will positively influence the child or young person's life should be identified before offering this treatment. The evidence reviewed for the guideline provided limited support for botulinum toxin type A in terms of achieving clinically important goals (including those related to function), and this discouraged the GDG from making a strong recommendation to offer treatment with botulinum toxin type A to all children and young people who are at GMFCS level I, II or III. Further research is needed to evaluate the effectiveness of botulinum toxin type A in comparison with other treatment options, particularly when used over long time periods (for example, 10 years) and involving repeat injections, in this population of children and young people. Outcomes relating to improvements in gross motor function and participation in activities, and the psychological impacts of these factors, should be evaluated as part of the research.

Source guidance details

Comes from guidance

Spasticity in under 19s: management

Number

CG145

Date issued

July 2012

Other details