Baclofen and Botulinum Toxin A Use in Tone Management for Children With Cerebral Palsy: A Review of Current Literature and Research Gaps in Pre- and Perioperative Care
Bibliographic record
Abstract
Cerebral palsy (CP) is a leading cause of motor disability in children. Many children with CP have hypertonia, and some will require orthopedic surgery. Botulinum toxin A (BoNT-A), a muscle relaxant, is commonly pre- or perioperatively injected to improve surgical outcomes and reduce postoperative pain and muscle tone. However, inconsistent evidence supporting its efficacy, potential research bias from industry sponsorship, and numerous adverse effects, such as long-term changes to muscle morphology, highlight the need for a better alternative. Preoperatively increasing the dose of oral baclofen, a first-line treatment for generalized CP-related hypertonia, may improve surgical outcomes with fewer long-term adverse effects. To date, the impact of an increased oral baclofen dose for this purpose has not yet been studied. This article reviews the current evidence on the effectiveness and safety of the three more commonly used antispastic treatments, BoNT-A, oral baclofen, and intrathecal baclofen, with the goal of trialing increased oral baclofen dose as an adjunct to surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".