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Peer-reviewedCC BY-NC 4.0Journal of Children's Orthopaedics

Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study

  • Anne Tabard-Fougère1,2,3
  • Alice Bonnefoy-Mazure2,3
  • Sophie Louis4
  • Stephane Armand2,3
  • Geraldo De Coulon1
  • Oscar Vazquez1
4 affiliations
  1. 1Pediatric Orthopedic and Traumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
  2. 2Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
  3. 3Centre of Research on Skeletal Muscle and Movement, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
  4. 4Division of Ergotherapy, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
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Abstract

Purpose: To compare long-term upper extremity functional evolution in children with spastic cerebral palsy (CP) receiving upper limb botulinum toxin A (BoNT-A) injections versus physical therapy (PT) alone.

Method: This retrospective cohort study included children aged 5–12 years at baseline with ≥2 Assisting Hand Assessment (AHA) evaluations over ≥3 years. The primary outcome was AHA score change. Secondary outcomes included changes in maximal wrist extension and forearm supination during functional tasks, measured from standardized videos by three blinded assessors. Changes were classified using minimal clinically important difference (MCID) thresholds: 5 units (AHA), 20° (wrist extension), and 30° (supination).

Results: Eleven patients with unilateral spastic CP (BoNT-A+PT, n=5; PT alone, n=6) were included. All BoNT-A+PT patients demonstrasted AHA deterioration (Δ = –3.6 ± 2.7), versus improvements in 5/6 PT patients (Δ = +9.0 ± 6.4). Wrist extension declined in all BoNT-A+PT patients (Δ = –53° ± 19°) versus 1/5 PT patients (Δ = –4° ± 8°). Supination deteriorated in 4/5 cases of BoNT-A+PT patients (Δ = –30° ± 7°) but remained stable in all PT patients (Δ = +2° ± 9°).

Conclusion: Upper limb BoNT-A was associated with systematic long-term functional decline, while PT alone preserved or improved function.

Significance of Study: These findings suggest that BoNT-A treatment may compromise long-term motor control and functional capacity, potentially influencing treatment algorithms in children with spastic cerebral palsy.

Level of evidence: III (retrospective cohort study).

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Cite

BibTeXRIS
BibTeX
@article{tabardfougere2026longterm,
  title = {{Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study}},
  author = {Anne Tabard-Fougère and Alice Bonnefoy-Mazure and Sophie Louis and Stephane Armand and Geraldo De Coulon and Oscar Vazquez},
  journal = {Journal of Children's Orthopaedics},
  year = {2026},
  month = aug,
  doi = {10.1177/18632521261475145},
  url = {https://doi.org/10.1177/18632521261475145},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Long-term functional decline following upper limb botulinum toxin injections in children with unilateral cerebral palsy: A preliminary retrospective 5-year follow-up case-control study
AU  - Anne Tabard-Fougère
AU  - Alice Bonnefoy-Mazure
AU  - Sophie Louis
AU  - Stephane Armand
AU  - Geraldo De Coulon
AU  - Oscar Vazquez
PY  - 2026
DA  - 2026/08/13
JO  - Journal of Children's Orthopaedics
DO  - 10.1177/18632521261475145
UR  - https://doi.org/10.1177/18632521261475145
AB  - Purpose: To compare long-term upper extremity functional evolution in children with spastic cerebral palsy (CP) receiving upper limb botulinum toxin A (BoNT-A) injections versus physical therapy (PT) alone.  Method: This retrospective cohort study included children aged 5–12 years at baseline with ≥2 Assisting Hand Assessment (AHA) evaluations over ≥3 years. The primary outcome was AHA score change. Secondary outcomes included changes in maximal wrist extension and forearm supination during functional tasks, measured from standardized videos by three blinded assessors. Changes were classified using minimal clinically important difference (MCID) thresholds: 5 units (AHA), 20° (wrist extension), and 30° (supination).  Results: Eleven patients with unilateral spastic CP (BoNT-A+PT, n=5; PT alone, n=6) were included. All BoNT-A+PT patients demonstrasted AHA deterioration (Δ = –3.6 ± 2.7), versus improvements in 5/6 PT patients (Δ = +9.0 ± 6.4). Wrist extension declined in all BoNT-A+PT patients (Δ = –53° ± 19°) versus 1/5 PT patients (Δ = –4° ± 8°). Supination deteriorated in 4/5 cases of BoNT-A+PT patients (Δ = –30° ± 7°) but remained stable in all PT patients (Δ = +2° ± 9°).  Conclusion: Upper limb BoNT-A was associated with systematic long-term functional decline, while PT alone preserved or improved function.  Significance of Study: These findings suggest that BoNT-A treatment may compromise long-term motor control and functional capacity, potentially influencing treatment algorithms in children with spastic cerebral palsy.  Level of evidence: III (retrospective cohort study).
SN  - 1863-2521
SN  - 1863-2548
ER  -