TABLE II.
Characteristics, Precautions, and Adjunctive Treatment with BTX-A Injection*
| Study | Dose and Type | Injection Placement and Technique | Muscles Injected | Adjunctive Treatment with BTX-A Injection |
|---|---|---|---|---|
| Corry et al.25 | Botox (Allergan, USA) and (Dysport, Ponton, UK). Total amount injected, 250 U Botox at dose of 4-7 U/kg body weight or 160-400 U Dysport at dose of 8-9 U/kg. Max. dose, 0.4 mL volume | Location of injection determined by anatomical landmarks. EMLA local anesthetic cream (lignocaine)-lidocaine was applied before injection. Light general anesthesia used in 1 case | Biceps, brachialis, FCR, FCU, FDS and FDP, flexor pollicis longus, pronator teres | None |
| Fehlings et al.26 | Botox (Allergan, USA). 2-6 U/kg | Location determined by muscle palpation and anatomical landmarks | Biceps, pronator teres, FCU, adductor pollicis, finger flexors | OT |
| Speth et al.27 | Botox (Allergan). Max. per site, 50 U. Max. dose, 400 U | Location determined by electrical muscle stimulation. Injection was done under general anesthesia | Biceps, brachioradialis, pronator teres, FCU, FCR, flexor pollicis brevis, adductor pollicis | PT, OT, splinting |
| Lowe et al.28 | Botox (Allergan). Max. total dose, 8 U/kg, 100 U BTX-A with 5 mL normal saline solution | Location determined by electrical muscle stimulation. A combination of local anesthetic cream with light general anesthesia was used | Elbow flexors, pronator teres, pronator quadratus, wrist flexors, wrist extensors, finger flexors, thumb adductor, thumb opponens, thumb flexors | OT |
| Kawamura et al.29 | Botox (Allergan). High-dose group: 1.5 U/kg, max. 20 U/kg. Low-dose group, 30% of above dose | Location determined by anatomical landmarks and muscle palpation. Topical anesthetic was applied before injection | Biceps, brachioradialis, wrist/finger flexors, pronator teres, adductor pollicis, opponens pollicis | OT |
| Russo et al.30 | Botox (Allergan, Australia). Min. dose, 5.0 U/kg. Max. dose, 11.6 U/kg | Location determined by electrical muscle stimulation. Injection was done under general anesthesia | Elbow and wrist muscles, without specifying particular muscle injected | OT |
| Wallen et al.31 | Botox (Allergan, Australia). Dose per muscle, 0.5-2 U/kg. Max. dose, 12 U/kg | Location determined by electrical muscle stimulation. Injection was done under local anesthesia and nitrous oxide inhalation | Shoulder (pectoralis complex, latissimus dorsi, teres major), pronators, elbow flexors, wrist flexors, finger flexors, and thumb flexors, adductor, and opponens | OT in 1 group, none in another group |
| Redman et al.32 | BTX-A. Dose per upper limb muscle group, 0.5-2 U/kg. Max. dose, 12 U/kg | Not mentioned | Upper limb muscles, without specifying particular muscles | PT, OT |
| Rameckers et al.33 | Botox (Allergan). Max. per injection site, 50 U. Overall max., 400 U | Not mentioned | Adductor pollicis, flexor pollicis brevis, FCU, FCR, pronator teres, brachioradialis, biceps | PT, OT |
| Olesch et al.34 | Botox (Allergan, Australia). 10 U/0.1 mL. Total dose depended on weight of child | Location determined by electrical muscle stimulation. Injections was done under light general anesthesia (a short general anesthesia using sevoflurane) | Biceps, pronator teres, FCU, FCR, adductor pollicis, flexor pollicis longus, FDS, FDP | OT |
| Rameckers et al.35 | Botox (Allergan, USA). Max. per injection site, 50 U. Overall max., 400 U | Not mentioned | Adductor pollicis, flexor pollicis brevis, FCU, FCR, pronator teres, brachioradialis, biceps | OT |
| Koman et al.36 | Botox (Allergan). 1.4-12.5 U/kg | Location determined by anatomical landmarks; ultrasound-guided localization for smaller and deeper muscles | Shoulder, arm, forearm, hand, without specifying particular muscles | None |
| Ferrari et al.37 | Botox (Allergan). Total dose, <300 U | Location determined by ultrasound-guided muscle localization. Injections were done under light general anesthesia | Pronator teres, FCU, FCR, adductor pollicis, opponens pollicis, biceps, pectoralis major, FDS, flexor digitorum brevis, subscapularis | PT, splinting |
| Lidman et al.38 | Botox (Allergan Norden, Sweden). 3-30 U/mL. Dose was according to size of the muscles, degree of spasticity, and body weight | Injections guided by neuromuscular electrical stimulation using Teflon-coated BTX-A needle. Injections were done under general anesthesia or nitrous oxide sedation after local anesthetic EMLA cream was applied to injection sites | Biceps, brachialis, brachioradialis, pronator teres, pronator quadratus, adductor pollicis, flexor pollicis brevis | OT, splinting |
| Speth et al.39 | Dysport (Ipsen) or Botox (Allergan). Max. total Dysport dose, 1,000 U per session; max. total Botox dose, 333 U per session | Location determined by electrical stimulation using Teflon-coated needle. Injections were done under general anesthesia | Arm muscles, forearm muscles, intrinsic muscles of the hand. The most frequently injected muscles were the adductor pollicis, FCR, FCU, and pronator teres | Bimanual task-oriented therapy and splinting in 1 group, none in another group |
*
BTX-A = botulinum toxin A, FCR = flexor carpi radialis, FCU = flexor carpi ulnaris, FDS = flexor digitorum superficialis, FDP = flexor digitorum profundus, OT = occupational therapy, and PT = physical therapy.