Current clinical practice of Botulinum toxin A treatment in the lower extremities in children with cerebral palsy in Sweden – a population-based registry study

AIM: To describe current lower-extremity Botulinum toxin A (BTX-A) treatment in children with cerebral palsy (CP) in Sweden and compare treatment patterns in 2023-2024 with published nationwide data from 2014-2015. MATERIALS AND METHODS: This retrospective registry study included 3,216 children aged 1-15 years registered in the Swedish CP follow-up program and national quality registry (CPUP) in 2023-2024. BTX-A treatment was analyzed in relation to age, sex, Gross Motor Function Classification System (GMFCS) level, CP subtype, and injected muscle groups. Logistic regression and chi-square tests were used. RESULTS: BTX-A treatment of the lower extremities was reported for 828 children (26%). Treatment was most common at 7-9 years of age (33%) and among children at GMFCS levels III (38%) and IV (40%). Bilateral spastic CP had the highest treatment rate among CP subtypes (39%). The gastrocnemius-soleus was the most frequently treated muscle group (75% of treated children). The overall proportion treated was identical to that reported for 3,028 children in 2014-2015 (26%), but treatment in 2023-2024 was relatively more common in older children and at higher GMFCS levels. CONCLUSION: BTX-A remains an established component of lower-extremity spasticity management in Swedish children with CP. Treatment patterns have shifted slightly toward older children and those with more severe motor impairment, while the gastrocnemius-soleus remains the primary target muscle group. These findings may help rehabilitation teams anticipate treatment needs and coordinate BTX-A with other components of individualized rehabilitation.