Botulinum Neurotoxin Injections in Children with Self-Injurious Behaviors
Abstract
1. Introduction
2. Results
3. Discussion
4. Conclusions
5. Materials and Methods
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Number of Patients (%) |
---|---|
Sex | |
Male | 11 (65) |
Female | 6 (35) |
Age | |
11–35 mo | 4 (23.5) |
3–7 yr | 1 (5.9) |
8–12 yr | 3 (17.6) |
13–20 yr | 9 (52.9) |
Comorbid Diagnoses 1 | |
Intellectual disability/Global developmental delay | 10 (58.8) |
Tourette syndrome/Chronic motor tic disorder | 4 (23.5) |
Autism spectrum disorder | 3 (17.6) |
None of the above | 1 (5.9) |
Patient | Sex | Age | Phenomenology | Comorbid Diagnosis/Etiology | Prior Treatments | BoNT Outcome |
---|---|---|---|---|---|---|
1 | M | 16 mo | Self-injurious biting | Global developmental delay/congenital insensitivity to pain with anhidrosis | Tooth extraction Physical restraints | 1 |
2 | F | 16 yr | Whiplash neck tics | Tourette syndrome | None | Unknown a |
3 | F | 18 yr | Hitting/punching stereotypy | Intellectual disability/Aicardi syndrome | Physical restraints Alpha-2 agonists Benzodiazepines | 4 |
4 | M | 15 yr | Forceful arm supination tics | Tourette syndrome | Antipsychotics VMAT-2 inhibitors | 4 b |
5 | F | 11 yr | Self-injurious biting | Intellectual disability/cardiofaciocutaneous syndrome | Antipsychotics | 1 |
6 | M | 13 yr | Whiplash neck tics | Chronic motor tic disorder | Antipsychotics Muscle relaxants | 1 |
7 | M | 16 yr | Hitting/punching stereotypy | Intellectual disability | Physical restraints Antipsychotics SSRI/antagonists | 4 |
8 | F | 17 yr | Whiplash neck tics | Intellectual disability | None | 1 |
9 | M | 11 mo | Self-injurious biting | Recurrent nocturnal tongue biting | Benzodiazepines | 1 |
10 | M | 5 yr | Self-injurious biting | Intellectual disability | Physical restraints VMAT-2 inhibitors Alpha-2 agonists | 1 |
11 | M | 23 mo | Self-injurious biting | Global developmental delay/Lesch-Nyhan syndrome | Physical restraints Benzodiazepines | 1 c |
12 | F | 22 mo | Self-injurious biting | Global developmental delay/perinatal tuberculosis meningitis with ischemic stroke | Teeth extraction Physical restraints Benzodiazepines | 1 |
13 | M | 17 yr | Hitting/punching stereotypy | Intellectual disability and autism spectrum disorder | Physical restraints SSRI/antagonists Mood stabilizers Antipsychotics Benzodiazepines VMAT-2 inhibitors Alpha-2 agonists | 4 |
14 | F | 15 yr | Whiplash neck tics | Autism spectrum disorder | Mood stabilizers Alpha-2 agonists SSRI/antagonists | 1 |
15 | M | 10 yr | Whiplash neck tics | Autism spectrum disorder/creatine transporter deficiency | Antipsychotics Alpha-2 agonists Naltrexone SSRI/antagonists | 4 |
16 | M | 11 yr | Kicking stereotypy | Intellectual disability/mitochondrial disorder | Physical restraints VMAT-2 inhibitors Benzodiazepines | 1 c |
17 | M | 18 yr | Whiplash neck tics | Tourette syndrome | Behavioral therapy Antipsychotics VMAT-2 inhibitors Mood stabilizers | 4 |
Phenomenology | Body Region Injected | Number of Patients (%) | Meaningful Benefit (%) | Duration of Benefit (Weeks) 1 |
---|---|---|---|---|
Self-injurious Biting | Face | 6 (35.3) | 6 (100) | 6–12 |
Tics Whiplash neck extension tics Forceful arm supination | Neck Upper Extremity | 7 (41.2) 6 1 | 3 1 (42.9) 3 2 0 | 8–16 |
Stereotypy Hitting/Punching Kicking | Upper Extremity Lower Extremity | 4 (23.5) 3 1 | 1 (25) 0 1 | 8 |
Body Region | Muscles Injected | Typical Dose per Muscle (Mean) (U) | Dose Variability (Standard Deviation) (U) | Dose Limits per Muscle (Min–Max) (U) |
---|---|---|---|---|
Face | Masseter | 88.3 | 13.3 | 80–110 |
Temporalis | 57.5 | 15.1 | 35–80 | |
Neck | Splenius capitis | 65 | 4.1 | 60–70 |
Scalene | 63.8 | 37.7 | 40–120 | |
Sternocleidomastoid | 40 | 10 | 30–50 | |
Upper Extremity | Biceps | 300 | 100 | 200–400 |
Pectoralis major * | 100 | N/A | N/A | |
Latissimus dorsi * | 200 | N/A | N/A | |
Supinator * | 40 | N/A | N/A | |
Lower Extremity | Iliopsoas * | 200 | N/A | N/A |
Gluteus maximus * | 300 | N/A | N/A | |
Adductor * | 200 | N/A | N/A |
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Hull, M.; Parnes, M.; Jankovic, J. Botulinum Neurotoxin Injections in Children with Self-Injurious Behaviors. Toxins 2023, 15, 236. https://doi.org/10.3390/toxins15040236
Hull M, Parnes M, Jankovic J. Botulinum Neurotoxin Injections in Children with Self-Injurious Behaviors. Toxins. 2023; 15(4):236. https://doi.org/10.3390/toxins15040236
Chicago/Turabian StyleHull, Mariam, Mered Parnes, and Joseph Jankovic. 2023. "Botulinum Neurotoxin Injections in Children with Self-Injurious Behaviors" Toxins 15, no. 4: 236. https://doi.org/10.3390/toxins15040236
APA StyleHull, M., Parnes, M., & Jankovic, J. (2023). Botulinum Neurotoxin Injections in Children with Self-Injurious Behaviors. Toxins, 15(4), 236. https://doi.org/10.3390/toxins15040236