Botulinum Toxin A Compared with Stretching Casts in the Treatment of Spastic Equinus: A Randomised Prospective Trial

Corry, Ian S.; Cosgrove, Aidan; Duffy, C.M.; McNeill, S. Alan; Taylor, T C; Graham, H. Kerr

doi:10.1097/01241398-199805000-00006

Cited by 185 publications

(281 citation statements)

References 15 publications

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“…BTX-A has a variety of short-term successful outcome parameters, such as a reduction of muscle tone [63,85], an increased range of joint motion [32,63,85,87], an improved gait pattern [32,87], an increased muscle length [88] and improved function through the Gross Motor Function Measure [39]. Different types of assessment tools were used in the performed studies until now, which may explain the variety of treatment outcome parameters.…”

Section: Evaluation Of Outcomementioning

confidence: 99%

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb

Molenaers

Campenhout

Fagard³

et al. 2010

Journal of Children's Orthopaedics

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Purpose The purpose of this review is to clarify the role of botulinum toxin serotype A (BTX-A) in the treatment of children with cerebral palsy (CP), with a special focus on the lower limb. Background The treatment of spasticity is central in the clinical management of children with CP. BTX-A blocks the release of acetylcholine at the motor end plate, causing a temporary muscular denervation and, in an indirect way, a reduced spasticity. Children with increased tone develop secondary problems over time, such as muscle contractures and bony deformities, which impair their function and which need orthopaedic surgery. However in these younger children, delaying surgery is crucial because the results of early surgical interventions are less predictable and have a higher risk of failure and relapse. As BTX-A treatment reduces tone in a selective way, it allows a better motor control and muscle balance across joints, resulting in an improved range of motion and potential to strengthen antagonist muscles, when started at a young age. The effects are even more obvious when the correct BTX-A application is combined with other conservative therapies, such as physiotherapy, orthotic management and casts. There is now clear evidence that the consequences of persistent increased muscle tone can be limited by applying an integrated multi-level BTX-A treatment approach. Nevertheless, important challenges such as patient selection, defining appropriate individual goals, timing, dosing and dilution, accuracy of injection technique and how to measure outcomes will be questioned. Therefore, ''reflection is more important than injection'' remains an actual statement.

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Section: Evaluation Of Outcomementioning

confidence: 99%

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb

Molenaers

Campenhout

Fagard³

et al. 2010

Journal of Children's Orthopaedics

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show abstract

“…Spastisite, üst motor nöron disfonksiyonu sonucu olan birçok hastada, yaygın ve engelleyici bir problemdir. Spastisitenin ana özelliklerinden biri olan yüksek kas aktivitesi ve tonus artışı, serebral palsili hastalarda yaygın bir sağlık sorundur [2].…”

Section: Introductionunclassified

The efficiency of high dose botulinum toxin type-A in the treatment of cerebral palsy

Dai

2014

J Clin Exp Invest

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Objective: Cerebral palsy is the most common cause of severe physical disability in childhood. Botulinum toxin type A (BTX-A), has rapidly gained acceptance as a different treatment for spasticity. However, no consensus exists among clinicians about optimal dose of BTX-A in pediatric patients. Doses of 2-6 U/ kg bodyweight with a maximum total dose of 29U/kg have been reported. This study was conducted due to uncertain dosage rage in pediatric use. Methods:In this study, 12 patients with cerebral palsy and spastic eqinus foot deformity who referred to our center, were treated with BTX-A in the dosage of 25 U/kg. After treatment of BTX-A, patients were followed up total of 6 months. Three months after treatment, Gross motor functional measurement (GMFM) and Modified Ashwort scale (MAS) were done. At the same time, questionnaires (PCQ) were filled for possible side effects.Results: Average age of 6 girls and 6 boys were 4.5 ± 2.8 years. GMFM and MAS were done before and 3 months after treatment and were found statistically significant (p<0.05). Muscle soreness was the most common symptom at PCQ forms. Conclusion:Using these two objective scales and PCQ form, high dose of BTX-A treatment was found statistically successful. Larger dose of BTX-A was used which was considered safe, effective and better tolerated by children. Titration of the dose of BTX-A, should be individualized for each patient due to different level of spasticity affecting patients in different ways. J Clin Exp Invest 2014; 5 (1): 93-97

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“…In a number of controlled studies, beneficial effects of toxin treatment, over and above the placebo effects, have been reported for lowerlimb spasticity associated with CP (Chutorian and Root 1995;Corry et al 1997Corry et al , 1999Sutherland et al 1999;Koman et al 2000). In addition, the beneficial effect of BTX-A has been demonstrated when compared with splinting and stretching casts (Corry et al 1998, Flett et al 1999.…”

mentioning

confidence: 96%

“…However, in most studies in children with CP, injections have been made into the gastrocnemius muscle (Koman et al 1993(Koman et al , 1994Cosgrove et al 1994;Chutorian and Root 1995;Corry et al 1998;Flett et al 1999;Eames et al 1999;Sutherland et al 1999;Boyd et al 2000;Koman et al 2000).…”

mentioning

confidence: 99%

Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double‐blind, placebo‐controlled, dose‐ranging study

Baker

Jasiński

Maciąg-Tymecka³

et al. 2002

Develop Med Child Neuro

119

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This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX‐A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 1920, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.

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Botulinum Toxin A Compared with Stretching Casts in the Treatment of Spastic Equinus: A Randomised Prospective Trial

Cited by 185 publications

References 15 publications

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb

The efficiency of high dose botulinum toxin type-A in the treatment of cerebral palsy

Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double‐blind, placebo‐controlled, dose‐ranging study

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