{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:10:24Z","timestamp":1783930224773,"version":"3.55.0"},"reference-count":32,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;amp;R"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effects of incobotulinumtoxinA (incoBoNT\u2010A) in children and adolescents with spastic cerebral palsy (CP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Literature survey<\/jats:title>\n                    <jats:p>CP is a leading cause of childhood disability, with spasticity present in &gt;90% of cases. BoNT\u2010A is widely used to manage spasticity, improving function and quality of life. IncoBoNT\u2010A, a highly purified BoNT\u2010A formulation, offers reduced immunogenicity and greater stability across storage conditions. Although previous reviews have evaluated BoNT\u2010A in CP, none have focused specifically on incoBoNT\u2010A.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>For this systematic review, we searched databases and trial registries through February 2025 for randomized controlled trials (RCTs) comparing incoBoNT\u2010A with placebo, other BoNT\u2010A formulations, or different doses in patients \u226418\u2009years with spastic CP. Meta\u2010analyses used random\u2010 or fixed\u2010effects models; evidence certainty was rated with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Synthesis<\/jats:title>\n                    <jats:p>We included four RCTs. IncoBoNT\u2010A showed very uncertain effects compared to onabotulinumtoxinA (onaBoNT\u2010A) on spasticity, gait, and adverse events. Higher doses of incoBoNT\u2010A (\u22656\u2009units\/kg) showed minimal improvement in spasticity (mean difference: \u22120.19, 95% confidence interval [CI]: \u22120.36 to \u22120.01; moderate certainty) compared to lower doses (\u22644\u2009units\/kg), with no meaningful differences in motor function, global impression of change, or adverse events. Certainty ranged from moderate to very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The available evidence is insufficient to determine whether incoBoNT\u2010A offers any advantages or disadvantages compared to onaBoNT\u2010A in children with spastic CP, given the very low certainty of the data. Similarly, using a higher dose of incoBoNT\u2010A is unlikely to yield a meaningful clinical benefit compared to a lower dose. Further high\u2010quality trials are needed to reduce uncertainty and guide clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.70061","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T12:15:59Z","timestamp":1763381759000},"page":"765-778","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of\n                    <scp>incobotulinumtoxinA<\/scp>\n                    in children and adolescents with spastic cerebral palsy: A systematic review of randomized controlled trials"],"prefix":"10.1002","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1466-1008","authenticated-orcid":false,"given":"Roger","family":"De la Cerna\u2010Luna","sequence":"first","affiliation":[{"name":"Physical Medicine and Rehabilitation Department Hospital Nacional Edgardo Rebagliati Martins  Lima 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