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<p>Botulinum toxin type A (BoNT-A) is a key intervention for the management of spasticity in children with cerebral palsy (CP); however, the functional factors associated with its use remain incompletely defined. This cross-sectional study examined whether standardized functional classification levels across manual, motor, and communication domains are associated with BoNT-A administration in routine clinical practice. The study included 52 children with spastic hemiplegic and diplegic CP; children with quadriplegic involvement were excluded to enhance cohort homogeneity and focus on activity-oriented rehabilitation goals. Functional status was assessed using the Manual Ability Classification System (MACS), the Communication Function Classification System (CFCS), and the Korean–Modified Functional Severity Score (KMFSS). Children who received BoNT-A demonstrated significantly greater manual dysfunction than those who did not (median [IQR] MACS: 3.0 [2.0–4.0] vs. 2.0 [1.0–3.5]; <i>p</i> = 0.016), whereas no significant differences were observed for CFCS (<i>p</i> = 0.299) or KMFSS (<i>p</i> = 0.956). In multivariable logistic regression analysis adjusted for age and sex, MACS level was the only variable significantly associated with BoNT-A administration in this cohort(β = −0.721, <i>p</i> = 0.036). These findings suggest that BoNT-A use in pediatric CP may be more closely associated with upper limb functional impairment than with global motor or communicative classifications. This observation may reflect a potential “focal-to-global” gap in clinical assessment and warrants further investigation in larger, prospective studies.</p>

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Functional classification systems and their association with botulinum toxin type a use in pediatric cerebral palsy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月30日

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  • Duygu Kurtuluş,
  • Gokhan Basar,
  • Ozlem Kaleoglu

摘要

Botulinum toxin type A (BoNT-A) is a key intervention for the management of spasticity in children with cerebral palsy (CP); however, the functional factors associated with its use remain incompletely defined. This cross-sectional study examined whether standardized functional classification levels across manual, motor, and communication domains are associated with BoNT-A administration in routine clinical practice. The study included 52 children with spastic hemiplegic and diplegic CP; children with quadriplegic involvement were excluded to enhance cohort homogeneity and focus on activity-oriented rehabilitation goals. Functional status was assessed using the Manual Ability Classification System (MACS), the Communication Function Classification System (CFCS), and the Korean–Modified Functional Severity Score (KMFSS). Children who received BoNT-A demonstrated significantly greater manual dysfunction than those who did not (median [IQR] MACS: 3.0 [2.0–4.0] vs. 2.0 [1.0–3.5]; p = 0.016), whereas no significant differences were observed for CFCS (p = 0.299) or KMFSS (p = 0.956). In multivariable logistic regression analysis adjusted for age and sex, MACS level was the only variable significantly associated with BoNT-A administration in this cohort(β = −0.721, p = 0.036). These findings suggest that BoNT-A use in pediatric CP may be more closely associated with upper limb functional impairment than with global motor or communicative classifications. This observation may reflect a potential “focal-to-global” gap in clinical assessment and warrants further investigation in larger, prospective studies.