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Botulinum Toxin: Techniques Within Pediatric Physiatry.

Publication ,  Journal Article
Paulson, A; Zigler, CK; Houtrow, A; Pruitt, D
Published in: PM R
January 2019

BACKGROUND: Intramuscular botulinum toxin injections are used for treatment of focal spasticity in children, particularly in those with a diagnosis of cerebral palsy. There are a variety of techniques used when performing botulinum toxin injections without clear standards for pediatric providers. OBJECTIVE: To describe current practice techniques for botulinum toxin injections among pediatric physiatrists. DESIGN: Cross-sectional survey using RedCap Software. SETTING: Pediatric physiatrists who perform botulinum toxin injections. PARTICIPANTS: Survey of 307 pediatric physiatrists. METHODS: Analysis of data from the 2017 practice survey of pediatric physiatrists in the United States. MAIN OUTCOME MEASUREMENTS: Physicians were asked the primary botulinum toxin used, common dosing information, the role of localization, and the role of sedation and distraction in their practice. RESULTS: Nearly all pediatric physiatrists use OnabotulinumtoxinA as the primary formulation of botulinum toxin. The maximum dose per body weight used per injection series had a median of 15 units/kilogram and a median maximum total dose of 500 units. Sixty-five percent of pediatric physiatrists report using sedation, of any type, for botulinum toxin injections. When using sedation, the most common primary method was general anesthesia (38.9%), followed by enteral or nasal anxiolytic with the patient awake (26.2%). The most common reported intended injection site for botulinum toxin was "in multiple sites spread throughout the muscle" (67.9%), and then "one site of the muscle at the motor point" (17.1%). Large muscles were injected using primarily anatomic guidance (75.6%) and electromyography (50.8%), and small muscles were primarily completed with electromyography (73.6%) and anatomic guidance (49.2%). CONCLUSION: There is considerable variability present in one common procedure performed by pediatric physiatrists. LEVEL OF EVIDENCE: NA.

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Published In

PM R

DOI

EISSN

1934-1563

Publication Date

January 2019

Volume

11

Issue

1

Start / End Page

38 / 44

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Practice Patterns, Physicians'
  • Physiatrists
  • Pediatrics
  • Neuromuscular Agents
  • Muscle Spasticity
  • Male
  • Injections, Intramuscular
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Paulson, A., Zigler, C. K., Houtrow, A., & Pruitt, D. (2019). Botulinum Toxin: Techniques Within Pediatric Physiatry. PM R, 11(1), 38–44. https://doi.org/10.1016/j.pmrj.2018.06.004
Paulson, Andrea, Christina K. Zigler, Amy Houtrow, and David Pruitt. “Botulinum Toxin: Techniques Within Pediatric Physiatry.PM R 11, no. 1 (January 2019): 38–44. https://doi.org/10.1016/j.pmrj.2018.06.004.
Paulson A, Zigler CK, Houtrow A, Pruitt D. Botulinum Toxin: Techniques Within Pediatric Physiatry. PM R. 2019 Jan;11(1):38–44.
Paulson, Andrea, et al. “Botulinum Toxin: Techniques Within Pediatric Physiatry.PM R, vol. 11, no. 1, Jan. 2019, pp. 38–44. Pubmed, doi:10.1016/j.pmrj.2018.06.004.
Paulson A, Zigler CK, Houtrow A, Pruitt D. Botulinum Toxin: Techniques Within Pediatric Physiatry. PM R. 2019 Jan;11(1):38–44.
Journal cover image

Published In

PM R

DOI

EISSN

1934-1563

Publication Date

January 2019

Volume

11

Issue

1

Start / End Page

38 / 44

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Practice Patterns, Physicians'
  • Physiatrists
  • Pediatrics
  • Neuromuscular Agents
  • Muscle Spasticity
  • Male
  • Injections, Intramuscular