{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T04:19:34Z","timestamp":1743826774573,"version":"3.40.3"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To identify the incidence and type of adverse events reported after chemodenervation with onabotulinum neurotoxin A (BoNT\u2010A) in children with hypertonia and sialorrhea and compare adverse events in the on\u2010label or off\u2010label use of BoNT\u2010A with regard to dose, patient's age, and location of the injection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Using a retrospective chart review, we studied BoNT\u2010A injections occurring from January 2017 to December 2020 in patients at a pediatric hospital. The electronic health record was examined to identify adverse events reported within 2\u2009months of the injection. Data included the patient's age, sex, race, and ethnicity, as well as the type of toxin injected, the dose, the location of injection, and the patient's weight.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analyzed 1733 procedures. Adverse events were infrequent (2.5%) and not serious, most commonly reported as pain or discomfort. All adverse events were temporary and there were no deaths. We did not observe a meaningful difference in the frequency of adverse events for injections that exceeded the 2022 US Food and Drug Administration (FDA)\u2010approved maximum dose compared to injections that were within the FDA\u2010approved dose range. The likelihood of adverse events did not increase with higher doses of BoNT\u2010A. More adverse events were reported for injection into the salivary glands (4.37%) than into the extremities (2.26%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Higher doses of injected BoNT\u2010A in a pediatric population may be safe. Further work is needed to investigate the relationship between dose and efficacy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.16125","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T18:29:27Z","timestamp":1729535367000},"page":"648-655","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adverse events after chemodenervation with onabotulinum neurotoxin A in children with hypertonia and sialorrhea"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0873-3321","authenticated-orcid":false,"given":"Jacqueline","family":"Krieger","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Thomas Jefferson University Hospital  Philadelphia PA USA"},{"name":"Division of Rehabilitation Medicine Children's Hospital of Philadelphia  Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8427-3051","authenticated-orcid":false,"given":"Laura","family":"Prosser","sequence":"additional","affiliation":[{"name":"Division of Rehabilitation Medicine Children's Hospital of Philadelphia  Philadelphia PA USA"},{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine  Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah Helen","family":"Evans","sequence":"additional","affiliation":[{"name":"Division of Rehabilitation Medicine Children's Hospital of Philadelphia  Philadelphia PA USA"},{"name":"Department of Pediatrics University of Pennsylvania Perelman School of Medicine  Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20088"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702\u2010008\u20100175\u20108"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2014.01.050"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pmrj.12713"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14872"},{"volume-title":"CHOP Center for Rehabilitation Research registry","year":"2021","author":"Camacho P.","key":"e_1_2_9_7_1"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-0749"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073813495306"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13995"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20108749.2010.03814.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20108749.2007.00818.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13135"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins5030524"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPB.0000000000001055"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2008.10.006"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13333"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2015.09.014"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2018.06.004"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162201000445"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-973475"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.2310\/7010.2006.00041"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13286"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20108749.2009.03583.x"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13686"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins7051629"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2010.02.00"}],"container-title":["Developmental Medicine &amp; 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