{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:14:26Z","timestamp":1792034066587,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T00:00:00Z","timestamp":1605657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014382","name":"Ipsen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014382","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the efficacy and safety of repeat abobotulinumtoxinA injections in reducing upper limb spasticity in children with cerebral palsy (CP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a double\u2010blind, repeat\u2010cycle study (NCT02106351) in children with CP (2\u201317y). Children were randomized to receive 2U\/kg (control), 8U\/kg, or 16U\/kg abobotulinumtoxinA injections into the target muscle group (wrist or elbow flexors) and additional muscles alongside occupational therapy via a home\u2010exercise therapy program (HETP; minimum five 15min sessions\/wk). Children received 8U\/kg or 16U\/kg plus HETP in cycles 2 to 4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During cycle 1, 210 children (126 males, 84 females; mean age [SD] 9y [4y 5mo], range 2\u201317y; <jats:italic>n<\/jats:italic>=70\/group) had at least one upper limb abobotulinumtoxinA injection and 209 complied with the HETP. At week 6 of cycle 1, children in the 8U\/kg or 16U\/kg groups had significantly lower Modified Ashworth scale scores versus the 2U\/kg group (primary outcome: treatment differences of \u20130.4 [<jats:italic>p<\/jats:italic>=0.012] and \u20130.7 [<jats:italic>p<\/jats:italic>&lt;0.001] respectively). All groups improved on Physician Global Assessment and children in all groups achieved their treatment goals at least as expected. Therapeutic benefits were sustained during cycles 2 to 4; muscular weakness was the only treatment\u2010related adverse event reported in at least one child\/group (4.3% and 5.7% vs 1.4% respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Treatment with 8U\/kg or 16U\/kg abobotulinumtoxinA significantly reduced upper limb spasticity versus the 2U\/kg control dose. Therapeutic benefits of abobotulinumtoxinA plus HETP were sustained with repeat treatment cycles.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>AbobotulinumtoxinA injections significantly reduced upper limb spasticity in children with cerebral palsy.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Children treated with abobotulinumtoxinA and targeted home exercises showed global improvement and goal attainment.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Benefits were sustained over 1 year with repeat cycles of abobotulinumtoxinA and home exercises.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>AbobotulinumtoxinA injections into the upper limb were well tolerated over 1 year.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.14733","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T19:26:52Z","timestamp":1605727612000},"page":"592-600","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Efficacy and safety of abobotulinumtoxinA for upper limb spasticity in children with cerebral palsy: a randomized repeat\u2010treatment study"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1855-8654","authenticated-orcid":false,"given":"Mauricio R","family":"Delgado","sequence":"first","affiliation":[{"name":"Department of Neurology University of Texas Southwestern Medical Center Scottish Rite Hospital for Children Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Tilton","sequence":"additional","affiliation":[{"name":"Department of Neurology LSUHSC and Children's Hospital New Orleans New Orleans LA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Carranza\u2010Del R\u00edo","sequence":"additional","affiliation":[{"name":"Hospital San Jos\u00e9 Celaya Celaya, Guanajuato Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6552-7204","authenticated-orcid":false,"given":"Nigar","family":"Dursun","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Faculty of Medicine Kocaeli University Kocaeli Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Bonikowski","sequence":"additional","affiliation":[{"name":"Mazovian Neuropsychiatry Center Zag\u00f3rze, nr Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Resa","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Istanbul Faculty of Medicine Istanbul University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iwona","family":"Maciag\u2010Tymecka","sequence":"additional","affiliation":[{"name":"Rehabilitation Center KROK PO KROKU Gdansk Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Oleszek","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation University of Colorado and Children's Hospital Colorado Aurora CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Dabrowski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Physical Medicine and Rehabilitation Beaumont Health Oakland University School of Medicine Grosse Pointe MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne\u2010Sophie","family":"Grandoulier","sequence":"additional","affiliation":[{"name":"Atlanstat consultant for Ipsen Pharma Les Ulis France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Picaut","sequence":"additional","affiliation":[{"name":"Ipsen Pharma Cambridge MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Dysport in PUL study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14006"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11832-014-0593-0"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-1331.2001.00048.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61835-8"},{"key":"e_1_2_9_6_1","first-page":"CD003469","article-title":"Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy 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