{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:14:42Z","timestamp":1790921682615,"version":"4.1.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003252","name":"Lund University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003252","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Spasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017\u20132018 ranged from 8.6% in Denmark to 20% in Norway (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Mean age for undergoing SDR ranged from 4.5\u00a0years in Norway to 7.3\u00a0years in Denmark (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Mean age at ITB surgery ranged from 6.3\u00a0years in Norway to 10.1\u00a0years in Finland (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Mean age for BTX-A treatment ranged from 7.1\u00a0years in Denmark to 10.3\u00a0years in Iceland (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Treatment with SDR was most common in Gross Motor Function Classification System (GMFCS) level III, ITB in level V, and BTX-A in level I. The most common muscle treated with BTX-A was the calf muscle, with the highest proportion in GMFCS level I. BTX-A treatment of hamstring and hip muscles was most common in GMFCS levels IV-V in all countries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>There were statistically significant differences between countries regarding the proportion of children and adolescents with CP treated with the three spasticity reducing methods, mean age for treatment and treatment related to GMFCS level. This is likely due to differences in the availability of these treatment methods and\/or differences in preferences of treatment methods among professionals and possibly patients across countries.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-021-02289-3","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T08:02:32Z","timestamp":1626076952000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Treatment of spasticity in children and adolescents with cerebral palsy in Northern Europe: a CP-North registry study"],"prefix":"10.1186","volume":"21","author":[{"given":"Gunnar","family":"H\u00e4gglund","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Julsen","family":"Hollung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Ahonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guro L.","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gu\u00f0bj\u00f6rg","family":"Eggertsd\u00f3ttir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S.","family":"Gaston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reidun","family":"Jahnsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ira","family":"Jeglinsky-Kankainen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Nordbye-Nielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Tresoldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann I.","family":"Alriksson-Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"2289_CR1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14764","author":"SJ Hollung","year":"2020","unstructured":"Hollung SJ, H\u00e4gglund G, Gaston M, Seid AK, Alriksson-Schmidt A, Andersen GL. Point prevalence and motor function levels of 6 to 19 year olds with cerebral palsy in Scandinavia and Scotland. Dev Med Child Neurol. 2020. https:\/\/doi.org\/10.1111\/dmcn.14764.","journal-title":"Dev Med Child Neurol"},{"key":"2289_CR2","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1111\/j.1469-8749.2007.00246.x","volume":"49","author":"K Himmelmann","year":"2007","unstructured":"Himmelmann K, Hagberg G, Wiklund LM, Eek MN, Uvebrant P. Dyskinetic cerebral palsy: a population-based study of children born between 1991 and 1998. Dev Med Child Neurol. 2007;49:246\u201351.","journal-title":"Dev Med Child Neurol"},{"key":"2289_CR3","doi-asserted-by":"publisher","first-page":"744","DOI":"10.3109\/17453674.2011.618917","volume":"82","author":"G H\u00e4gglund","year":"2011","unstructured":"H\u00e4gglund G, Wagner P. Spasticity of the gastrocnemius muscle is related to the development of reduced passive dorsiflexion of the ankle in children with cerebral palsy. A registry analysis of 2796 examinations in 355 children. Acta Orthop. 2011;82:744\u20138.","journal-title":"Acta Orthop"},{"key":"2289_CR4","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1016\/j.jbiomech.2008.01.002","volume":"41","author":"JL Hicks","year":"2008","unstructured":"Hicks JL, Schwartz MH, Arnold AS, Delp SL. Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait. J Biomech. 2008;41:960\u20137.","journal-title":"J Biomech"},{"key":"2289_CR5","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1055\/s-0035-1571215","volume":"36","author":"R Kumar","year":"2016","unstructured":"Kumar R, Dhaliwal H, Kukreja R, Singh B. The botulinum toxin as a therapeutic agent: molecule structure and mechanism of action in motor and sensory systems. Semin Neurol. 2016;36:10\u20139.","journal-title":"Semin Neurol"},{"key":"2289_CR6","doi-asserted-by":"publisher","first-page":"193","DOI":"10.2340\/16501977-2211","volume":"49","author":"P Ertzgaard","year":"2017","unstructured":"Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen. J Rehabil Med. 2017;49:193\u2013203.","journal-title":"J Rehabil Med"},{"key":"2289_CR7","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1177\/088307389000500303","volume":"5","author":"WJ Peacock","year":"1990","unstructured":"Peacock WJ, Staudt LA. Spasticity in cerebral palsy and the selective posterior rhizotomy procedure. J Child Neurol. 1990;5:179\u201385.","journal-title":"J Child Neurol"},{"key":"2289_CR8","doi-asserted-by":"publisher","first-page":"e024438","DOI":"10.1136\/bmjopen-2018-024438","volume":"9","author":"AI Alriksson-Schmidt","year":"2019","unstructured":"Alriksson-Schmidt AI, Ahonen M, Andersen GL, Eggertsd\u00f3ttir G, Haula T, Jahnsen R, et al. CP-North: living life in the Nordic countries? A retrospective register research protocol on individuals with cerebral palsy and their parents living in Sweden, Norway, Denmark, Finland and Iceland. BMJ Open. 2019;9:e024438.","journal-title":"BMJ Open."},{"key":"2289_CR9","doi-asserted-by":"publisher","first-page":"830","DOI":"10.3109\/09638288.2016.1161843","volume":"39","author":"A Alriksson-Schmidt","year":"2017","unstructured":"Alriksson-Schmidt A, Arner M, Westbom L, Krumlinde-Sundholm L, Nordmark E, Rodby-Bousquet E, H\u00e4gglund G. A combined surveillance program and quality registry improves management of childhood disability. Disabil Rehabil. 2017;39:830\u20136.","journal-title":"Disabil Rehabil"},{"key":"2289_CR10","doi-asserted-by":"publisher","first-page":"457","DOI":"10.2147\/CLEP.S99474","volume":"8","author":"HM Rasmussen","year":"2016","unstructured":"Rasmussen HM, Nordbye-Nielsen K, M\u00f8ller-Madsen B, Johansen M, Ellitsgaard N, Pedersen CR, et al. The Danish cerebral palsy follow-up program. Clin Epidemiol. 2016;8:457\u201360.","journal-title":"Clin Epidemiol."},{"key":"2289_CR11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/1471-2431-7-41","volume":"7","author":"L Westbom","year":"2007","unstructured":"Westbom L, H\u00e4gglund G, Nordmark E. Cerebral palsy in a total population 4\u201311 years olds in southern Sweden. Prevalence and distribution according to different CP classification systems. BMC Pediatrics. 2007;7:41.","journal-title":"BMC Pediatrics."},{"key":"2289_CR12","unstructured":"Andersen GL, Hollung SJ, Jahnsen R, Elkj\u00e6r S, Klevberg G. Cerebral palsy registry of Norway and cerebral palsy follow-up program yearly report for 2019 [Norwegian]. Available at: https:\/\/www.kvalitetsregistre.no\/sites\/default\/files\/20_arsrapport_2019_cp.pdf."},{"key":"2289_CR13","unstructured":"Regionernes Kliniske Kvalitetsprogram (RKKP). Cerebral palsy follow-up program Denmark, annual report. Available at: http:\/\/www.cpop.dk\/wp-content\/uploads\/CPOP_Aarsrapport-2019_Offentlig-version_3.pdf."},{"key":"2289_CR14","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1177\/0036933018805897","volume":"64","author":"KE Bugler","year":"2019","unstructured":"Bugler KE, Gaston MS, Robb JE. Distribution and motor ability of children with cerebral palsy in Scotland: a registry analysis. Scott Med J. 2019;64:16\u201321.","journal-title":"Scott Med J"},{"key":"2289_CR15","doi-asserted-by":"publisher","first-page":"e1584","DOI":"10.1542\/peds.2014-0945","volume":"134","author":"M Hirvonen","year":"2014","unstructured":"Hirvonen M, Ojala R, Korhonen P, Haataja P, Eriksson K, Gissler M, Luukkaala T, Tammela O. Cerebral palsy among children born moderately and late preterm. Pediatrics. 2014;134:e1584.","journal-title":"Pediatrics"},{"key":"2289_CR16","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","volume":"39","author":"R Palisano","year":"1997","unstructured":"Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214\u201323.","journal-title":"Dev Med Child Neurol"},{"key":"2289_CR17","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","volume":"50","author":"RJ Palisano","year":"2008","unstructured":"Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008;50:744\u201350.","journal-title":"Dev Med Child Neurol"},{"key":"2289_CR18","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12887-020-1926-4","volume":"20","author":"A Lundkvist Josenby","year":"2020","unstructured":"Lundkvist Josenby A, Czuba T, Alriksson-Schmidt AI. Gender differences in treatments and interventions received by children and adolescents with cerebral palsy. BMC Pediatr. 2020;20:45.","journal-title":"BMC Pediatr."},{"key":"2289_CR19","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1186\/s12891-017-1880-y","volume":"18","author":"M Franz\u00e9n","year":"2017","unstructured":"Franz\u00e9n M, H\u00e4gglund G, Alriksson Schmidt A. Treatment with botulinum toxin A in a total population of children with cerebral palsy. A retrospective cohort registry study. BMC Musculoskeletal. 2017;18:520.","journal-title":"BMC Musculoskeletal."},{"key":"2289_CR20","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1111\/j.1469-8749.2007.00246.x","volume":"49","author":"K Himmelmann","year":"2007","unstructured":"Himmelmann K, Hagberg G, Wiklund LM, Eek MN, Uvebrant P. Dyskinetic cerebral palsy: a population-based study of children born between 1991 and 1998. Dev Med Child Neurol. 2007;49:246\u201351.","journal-title":"Dev Med Child Neurol"},{"key":"2289_CR21","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1055\/s-2003-39598","volume":"34","author":"G Blomstedt","year":"2003","unstructured":"Blomstedt G, Sainio K, Merikanto J, von Wendt L. Follow-up of children with cerebral palsy after selective posterior rhizotomy with intensive physiotherapy or physiotherapy alone. Neuropediatrics. 2003;34:67\u201371.","journal-title":"Neuropediatrics"},{"key":"2289_CR22","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1111\/dmcn.14320","volume":"62","author":"K Tedroff","year":"2020","unstructured":"Tedroff K, H\u00e4gglund G, Miller F. Long term effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol. 2020;62:554\u201362.","journal-title":"Dev Med Child Neurol."},{"key":"2289_CR23","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.pediatrneurol.2008.10.020","volume":"40","author":"S Brochard","year":"2009","unstructured":"Brochard S, Remy-Neris O, Filipetti P, Bussel B. Intrathecal baclofen infusion for ambulant children with cerebral palsy. Pediatr Neurol. 2009;40:265\u201370.","journal-title":"Pediatr Neurol"},{"key":"2289_CR24","doi-asserted-by":"publisher","unstructured":"Ross Raftemo AE, Mahendran A, Hollung SJ, Jahnsen RB, Lydersen S, Vik T, Andersen GL. Use of botulinum toxin A in children with cerebral palsy. Tidsskr Nor Laegeforen. 2019; 139. doi: https:\/\/doi.org\/10.4045\/tidsskr.18.0554.","DOI":"10.4045\/tidsskr.18.0554"},{"key":"2289_CR25","unstructured":"CPUP annual report 2020. Available at: https:\/\/cpup.se\/wp-content\/uploads\/2020\/10\/Arsrapport-CPUP-2020-10-19.pdf."},{"key":"2289_CR26","first-page":"317","volume":"19","author":"MAC Garcia","year":"2019","unstructured":"Garcia MAC, Vargas CD. Is somatosensory electrical stimulation effective in relieving spasticity? A systematic review. J Musculoskelet Neuronal Interact. 2019;19:317\u201325.","journal-title":"J Musculoskelet Neuronal Interact"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02289-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-021-02289-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02289-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T08:02:49Z","timestamp":1626076969000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-021-02289-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,12]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2289"],"URL":"https:\/\/doi.org\/10.1186\/s12883-021-02289-3","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,12]]},"assertion":[{"value":"24 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Data were collected from each program in an aggregated form and therefore it is not possible to link the data to any specific individual. Data for fewer than 5 people are reported as\u2009<\u20095 for non-disclosure of individuals. Nonetheless, each program has ethical approval for the CP-North research program in accordance to their local laws and regulations: CPUP-Sweden; Regional Ethics Board, Lund 2018\/491. CPOP-Norway; Regional Committees for Medical and Health Research Ethics 2017\/2457\/REK Southeast. CPIPS-Scotland; South East Scotland Research Ethics Service confirmed that ethical review was not required. Finland; the Helsinki University Hospital Ethical Committee IV HUS 3640\/2017. Denmark; the Danish Data protection Agency approved the study, reference number 2016\u2013051-000001, serial number 1774.\u00a0Iceland; the National Bioethics Committee in Iceland, VSN-19\u2013140. This study is based entirely on register data. None of the national ethics committees has deemed written or oral approval for participation necessary.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"276"}}