Botulinum Toxin A Injection for Spasticity in Diplegic-Type Cerebral Palsy

Abstract

Botulinum toxin type A can be both safe and effective in relieving spasticity in pediatric patients with cerebral palsy. In our prospective study, we evaluated the functional effect of botulinum toxin A in spastic diplegic-type cerebral palsy. Patients were examined on enrollment and at 1, 3, and 6 months after injection. Passive dorsiflexion of the ankle joint was measured using a goniometer as an angle of possible maximal dorsiflexion with the knee extended and flexed. Spasticity was graded using the Modified Ashworth Scale. Selective motor control at the ankle was assessed, and observational gait analysis was done. The functional status of the patients was determined by using the gross motor classification system. Botulinum toxin A was injected into the gastrocnemius muscle in all patients, and in four patients with concomitant jump knee gait, a hamstring muscle injection was added. Fourteen patients were included in the study. The mean age was 58.81 +/- 15.34 months. Following injection, spasticity was clinically decreased and statistically significant improvement was noticed in all clinical parameters after 1, 3, and 6 months of injection. The improvement in the clinical parameters decreased after 6 months but not to the baseline. One patient was Level II, four patients were Level III, and six patients were Level IV according to the Gross Motor Function Classification System at baseline. Improvement in the gross motor classification system is continued after 6 months in 12 children. The main goal of spasticity treatment in cerebral palsy is functional improvement. In our study, most of our patients had functional improvement according to the gross motor function classification system and did not change at 6 months.

Effects of botulinum toxin injections on function and quality of life in children with cerebral palsy

“…Similar benefits of BT [1,2] were mentioned in literature. Patients and methods A prospective study including 60 children, aged from 2 to 18 years old, who received repeated injections of BT was conducted.…”

Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis

“…A number of pharmacological agents and non-pharmacological treatments such as physical therapy, orthoses, and transcutaneous electrical nerve stimulation (TENS) have been tried for the treatment of spasticity and hypertonus 32 ) . Chemodenervation also called neurolysis or neuromuscular blockade are used to prevent nerve-muscle transmission with perineural injection of phenol 33 , 34 ) or ethyl alcohol 35 ) and intramuscular injection of botulinum toxin 36 , 37 , 38 , 39 , 40 , 41 ) . More invasive treatment options such as rhizotomy 42 , 43 , 44 ) and intrathecal baclofen 45 , 46 , 47 , 48 ) could be another choice for patients who are resistant to conventional treatments or have intractable spasticity.…”

Botulinum toxin type A in the treatment of lower-limb spasticity in children with cerebral palsy

“…Unlike adults, whose organisms are relatively static, children have two processes that are exclusive to childhood -growth and development -superimposed on the underlying spastic condition. Although the effects of BoNT/A are seen primarily in a reduction of hypertonia, the change in tonus can improve the child's balance, strength, motor control and fixed contractures 21 . As the child develops, the spastic muscles fail to grow as quickly as the neighboring structures, and dynamic structures are transformed into fixed contractures.…”

“…A critical assessment of the predictive factors for a good therapeutic result, the physiopathology of spasticity, the mechanism of action of BoNT/A and an understanding that a child's organism is undergoing constant change are directly related to the key elements for effective therapy using BoNT/A, namely, suitably chosen patients; clearly defined treatment objectives as a result of discussion with the patient and his/her family; and an effective long-term strategy for managing the changes that take place in a child with CP who is in a growth and development phase 21,22 .…”