Picelli Alessandro, Di Censo Rita, Tamburin Stefano, Smania Nicola, Filippetti Mirko
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy.
Department of Neurosciences, University Hospital of Verona, 37126 Verona, Italy.
Toxins (Basel). 2024 Nov 27;16(12):513. doi: 10.3390/toxins16120513.
Botulinum toxin type A1 is a first-line treatment for adult and pediatric spasticity. However, when considering the quantity of 150 kDa neurotoxin protein in relation to patient weight and the maximum recommended dose for treating adult and pediatric patients with spasticity, several concerns arise. First, the therapeutic margin (the ratio of the actual maximum quantity of toxin recommended for treating adult spasticity to its median lethal dose) appears to be relevant. Second, there is no consistency between adult and pediatric dosing of botulinum toxin type A1 for spasticity. The third point concerns the suitability of the recommended doses for treating spasticity in pediatric patients. Based on the average body weight of American children and adolescents, the maximum weight-based doses for abobotulinumtoxinA and onabotulinumtoxinA could be administered to children as young as 9 years old. Additionally, the maximum weight-based dose for incobotulinumtoxinA could be administered to children as young as 6 years old. The final point concerns managing the maximum dose of BoNT/A1 in pediatric patients with spasticity who weigh more than 25 kg for incobotulinumtoxinA, or more than 34 kg for abobotulinumtoxinA and onabotulinumtoxinA. No labeled recommendations are given on the weight cut-off for transitioning to adult dosing in pediatric patients.
A型肉毒毒素是治疗成人和儿童痉挛的一线药物。然而，在考虑150 kDa神经毒素蛋白的量与患者体重以及治疗成人和儿童痉挛的最大推荐剂量的关系时，出现了几个问题。首先，治疗窗（治疗成人痉挛推荐的实际最大毒素量与其半数致死剂量的比值）似乎很重要。其次，成人和儿童使用A型肉毒毒素治疗痉挛的剂量不一致。第三点涉及推荐剂量对治疗儿童痉挛的适用性。根据美国儿童和青少年的平均体重，阿柏西普肉毒毒素A和昂丹司琼肉毒毒素A基于体重的最大剂量可用于年仅9岁的儿童。此外，因克肉毒毒素A基于体重的最大剂量可用于年仅6岁的儿童。最后一点涉及对于体重超过25 kg（因克肉毒毒素A）、或超过34 kg（阿柏西普肉毒毒素A和昂丹司琼肉毒毒素A）的痉挛性儿科患者，如何管理A型肉毒毒素的最大剂量。对于儿科患者向成人剂量转换的体重临界值，没有给出标注的建议。
