Gunnar Hägglund1, Sandra Julsen Hollung2, Matti Ahonen3, Guro L Andersen2, Guðbjörg Eggertsdóttir4, Mark S Gaston5, Reidun Jahnsen6, Ira Jeglinsky-Kankainen7, Kirsten Nordbye-Nielsen8, Ilaria Tresoldi9, Ann I Alriksson-Schmidt10. 1. Department of Clinical Sciences Lund, Orthopedics, Lund University, Skåne University Hospital, 221 85, Lund, Sweden. gunnar.hagglund@med.lu.se. 2. Norwegian Quality and Surveillance Registry for Cerebral Palsy, Vestfold Hospital Trust, Tønsberg, Norway. 3. Department of Pediatric Orthopedics and Traumatology, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. 4. SLF´S Rehabilitation Center- Æfingastöðin, Reykjavík, Iceland. 5. Cerebral Palsy Integrated Pathway, Scotland. Royal Hospital for Sick Children, Edinburgh, UK. 6. Norwegian Quality and Surveillance Registry for Cerebral Palsy, Oslo University Hospital and University of Oslo, Oslo, Norway. 7. Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland. 8. Department of Children's Orthopedics, Danish Cerebral Palsy Follow-Up Program, Central Region Denmark, Danish Paediatric Orthopaedic Research Group, Aarhus University, Aarhus, Denmark. 9. Department of Children's Orthopedics, Danish Paediatric Orthopaedic Research Group, Aarhus University, Aarhus University Hospital, Aarhus, Denmark. 10. Department of Clinical Sciences Lund, Orthopedics, Lund University, Skåne University Hospital, 221 85, Lund, Sweden.
Abstract
BACKGROUND: Spasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries. METHODS: This registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland. RESULTS: A total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017-2018 ranged from 8.6% in Denmark to 20% in Norway (p < 0.01). Mean age for undergoing SDR ranged from 4.5 years in Norway to 7.3 years in Denmark (p < 0.01). Mean age at ITB surgery ranged from 6.3 years in Norway to 10.1 years in Finland (p < 0.01). Mean age for BTX-A treatment ranged from 7.1 years in Denmark to 10.3 years in Iceland (p < 0.01). Treatment with SDR was most common in Gross Motor Function Classification System (GMFCS) level III, ITB in level V, and BTX-A in level I. The most common muscle treated with BTX-A was the calf muscle, with the highest proportion in GMFCS level I. BTX-A treatment of hamstring and hip muscles was most common in GMFCS levels IV-V in all countries. CONCLUSION: There were statistically significant differences between countries regarding the proportion of children and adolescents with CP treated with the three spasticity reducing methods, mean age for treatment and treatment related to GMFCS level. This is likely due to differences in the availability of these treatment methods and/or differences in preferences of treatment methods among professionals and possibly patients across countries.
BACKGROUND:Spasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries. METHODS: This registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland. RESULTS: A total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017-2018 ranged from 8.6% in Denmark to 20% in Norway (p < 0.01). Mean age for undergoing SDR ranged from 4.5 years in Norway to 7.3 years in Denmark (p < 0.01). Mean age at ITB surgery ranged from 6.3 years in Norway to 10.1 years in Finland (p < 0.01). Mean age for BTX-A treatment ranged from 7.1 years in Denmark to 10.3 years in Iceland (p < 0.01). Treatment with SDR was most common in Gross Motor Function Classification System (GMFCS) level III, ITB in level V, and BTX-A in level I. The most common muscle treated with BTX-A was the calf muscle, with the highest proportion in GMFCS level I. BTX-A treatment of hamstring and hip muscles was most common in GMFCS levels IV-V in all countries. CONCLUSION: There were statistically significant differences between countries regarding the proportion of children and adolescents with CP treated with the three spasticity reducing methods, mean age for treatment and treatment related to GMFCS level. This is likely due to differences in the availability of these treatment methods and/or differences in preferences of treatment methods among professionals and possibly patients across countries.
Authors: Sandra J Hollung; Inger J Bakken; Torstein Vik; Stian Lydersen; Robert Wiik; Kari M Aaberg; Guro L Andersen Journal: Dev Med Child Neurol Date: 2019-07-04 Impact factor: 5.449