When to refer a child with Cerebral Palsy for Botox and Surgery?

Topic: When to refer a child with Cerebral Palsy for Botox and Surgery?

Talk By: Prof. Annemieke Buizer and Dr. Ronit Mesterman.

When: November 11, 2023, at 9:00 AM Eastern Time ( US / Canada ).

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​​Prof. Annemieke Buizer, MD, PhD in Medicine, is a pediatric rehabilitation physician and full professor of pediatric rehabilitation medicine. She is head of the multidisciplinary Cerebral Palsy Center of Expertise at Amsterdam University Medical Centers in Amsterdam, The Netherlands. In her clinical work and her research, she has a special focus on personalized interventions to improve mobility and understand underlying mechanisms of motor problems (from brain to muscle) in children with cerebral palsy.

Dr. Ronit Mesterman is an Associate Professor of Pediatrics at McMaster University and the Division Head of Developmental Pediatrics and Medical Director of Developmental Pediatrics and Rehabilitation at McMaster Children's Hospital. She is certified in pediatric neurology and developmental pediatrics.
She joined the faculty at McMaster University in 2004. Her dual training reflects her philosophy that developmental pediatrics and child neurology go together, and as such, she is working clinically in both divisions. Her main clinical as well as research interests are assessment and treatment of Cerebral Palsy. She has established a very busy multidisciplinary spasticity clinic. She is a member of the executive committee of CP-Net, A research-based initiative designed to improve the care of cerebral palsy from prevention to treatment in Ontario, Canada.

Deciding when to refer a child with cerebral palsy (CP) for botulinum toxin (e.g., Botox) treatment or surgery is a complex decision. The primary goal of treatment is to improve daily life activities comfort, and/or to prevent long-term problems such as contractures. Treatment decisions are made in a multidisciplinary team and should align with the child's and family's priorities. Specific recommendations will depend on the individual child's unique circumstances, including the type and severity of CP, age, functional level, and treatment goals. Botulinum toxin injections can be used to temporarily treat spasticity or dystonia focally, while spasticity surgery has a more generalized and permanent effect. Orthopedic surgery can be considered to treat contractures and deformities and can also have a role in the prevention of (hip) luxation. Knowledge of functional prognosis is an important element in deciding about treatment options and treatment goals. The WHO's International Classification of Functioning -Children and Youth (ICF-CY) offers a useful framework to formulate goals. In summary, the decision to refer a child with cerebral palsy for botulinum toxin treatment or surgery should be made on an individual basis, taking into account the child's personal and environmental factors, the functional level, and the input of a multidisciplinary medical team. 

During the grand round, treatment options for children with CP, the evidence for their efficacy, and a framework for clinical reasoning and decision-making will be presented. By attending the session, you will be able to learn the following points:

• Awareness of the scientific evidence of botulinum toxin treatment and surgery for improving function in children with CP.
• Understanding how motor impairments such as spasticity are related to mobility limitations in children with CP.
• Formulating treatment goals for children with CP according to the ICF-CY, considering functional prognosis.
• Familiarity with a framework for making treatment decisions and referring.

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