Effects of botulinum toxin type A on upper limb function in children with cerebral palsy: A systematic review

Alexander Reeuwijk*, Petra E.M. van Schie, Jules G. Becher, Gert Kwakkel

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review


OBJECTIVE: To evaluate whether botulinum toxin type A injections improve upper limb function in children with cerebral palsy.

METHODS: An extensive search was carried out in PUBMED, CINAHL, PICARTA, EMBASE, PEDRO and the Cochrane Controlled Trials Register. Controlled and uncontrolled studies were included and evaluated on the basis of a best evidence synthesis.

RESULTS: Twelve out of 645 identified studies were included: three randomized controlled trials (RCTs) (N=64) of high methodological quality, and nine uncontrolled studies (N=107) of sufficient methodological quality. In one of the three RCTs a short-term, significant decrease of spasticity was found in favour of the botulinum toxin type A group, which was supported by five of the seven uncontrolled studies that also measured spasticity. In one RCT significant changes in range of motion were reported for wrist and thumb extension. This finding was supported by two out of seven uncontrolled studies. One RCT reported a significant improvement in activities after one month, according to the Quality of Upper Extremity Skills Test and the Pediatric Evaluation Disability Inventory, whereas five out of the nine uncontrolled studies reported an improvement in functional activities.

CONCLUSION: Insufficient evidence is found for the effects of botulinum toxin type A injections to reduce spasticity or to increase range of motion and upper limb function in children with cerebral palsy. Besides differences in treatment goals, the lack of evidence is mainly due to the use of invalid assessment instruments and insufficient statistical power to demonstrate treatment effects.

Original languageEnglish
Pages (from-to)375-387
Number of pages13
JournalClinical Rehabilitation
Issue number5
Publication statusPublished - 1 May 2006

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