Botulinum toxin-A use in paediatric hypertonia: Canadian practice patterns

Can J Neurol Sci. 2012 Jul;39(4):508-15. doi: 10.1017/s0317167100014049.


Background: This study aims to assess current practices of Canadian physicians providing botulinum toxin-A (BoNT-A) treatments for children with hypertonia and to contrast these with international "best practice" recommendations, in order to identify practice variability and opportunities for knowledge translation.

Methods: Thirteen Canadian physicians assembled to develop and analyze results of a cross-sectional electronic survey, sent to 50 physicians across Canada.

Results: Seventy-eight percent (39/50) of physicians completed the survey. The most frequently identified assessment tools were Gross Motor Function Classification System, Modified Tardieu Scale and neurological examination. Goal-setting tools were infrequently utilized. Common indications for BoNT-A injections and the muscles injected were identified. Significant variability was identified in using BoNT-A for hip displacement associated with hypertonia. The most frequent adverse event reported was localized weakness; 54% reporting this "occasionally" and 15% "frequently". Generalized weakness, fatigue, ptosis, diplopia, dysphagia, aspiration, respiratory distress, dysphonia and urinary incontinence were reported rarely or never. For dosage, 52% identified 16 Units/kg body weight of Botox® as maximum. A majority (64%) reported a maximum 400 Units for injection at one time. For localization, electrical stimulation and ultrasound were used infrequently (38% and 19% respectively). Distraction was the most frequently used pain-management technique (64%).

Conclusions: Canadian physicians generally adhere to international best practices when using BoNT-A to treat paediatric hypertonia. Two knowledge-translation opportunities were identified: use of individualized goal setting prior to BoNT-A and enhancing localization techniques. Physicians reported a good safety profile of BoNT-A in children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Botulinum Toxins, Type A / therapeutic use*
  • Canada
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Disability Evaluation
  • Electromyography
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Muscle Hypertonia / drug therapy*
  • Muscle Hypertonia / physiopathology
  • Neuromuscular Agents / therapeutic use*
  • Pain Measurement
  • Pediatrics*
  • Practice Patterns, Physicians' / standards*
  • Severity of Illness Index
  • Treatment Outcome
  • Young Adult


  • Neuromuscular Agents
  • Botulinum Toxins, Type A