Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy

Abstract

At the group level, treating with BoNT-A prior to comprehensive rehabilitation did not add to the clinical effectiveness of rehabilitation. Thus, BoNT-A prescription and use should be critically reconsidered in this cerebral palsy age- and GMFCS-subgroup.

Botulinum toxin type A for spastic cerebral palsy: Is it time to change praxis?

“…The results and data from our study (3) can be viewed in correlation with the results reported by Schasfoort et al (1,2). We support their conclusions, that the role and therapeutic efficacy of BoNT-A, CR, and orthoses, alone and in combination, should be defined in spasticity treatment in children with SCP.…”

“…We read the articles by Schasfoort et al (1,2) with great interest, since the use of botulinum toxin type A (BoNT-A) in children with spastic cerebral palsy (SCP) has been the subject of our research. The great congruence in study design, subjects/patients and methods with one of our papers prompts us to describe our observations, comparisons and conclusions, and to publish certain data from our study (3) for the first time here.…”

“…In designing our study, based on our previous experience we decided to apply BoNT-A with the aim of correcting dynamic spastic equinus, if the following inclusion criterion was fulfilled: dynamic contracture of the ankle joint with inadequate response (no reduction in spasticity over a period of 2 months of continuous physical therapy (CPT)) (3). The design of CPT is identical to intensive physiotherapy alone and, if necessary, it can be combined with ankle-foot orthoses to achieve full comprehensive rehabilitation (CR), as described by Schasfoort et al (1,2).…”

The evidence for noncosmetic uses of botulinum toxin

“…Vaginismus (C) and vulvodynia (B) 28 Chronic low back pain (B) 17 Cerebral palsy (B) 19,20,30 Neonatal brachial plexus palsy (B) 21 Post-stroke spasticity (C) 5,22 Unclear benefit Achalasia (B) 14 Interstitial cystitis (B) 28 Benign prostatic hypertrophy (B) 29 Chronic pelvic pain and spasm (B) 28 Myofascial pain syndrome (B) 18…”

“…19 A multicenter Dutch study of 65 children compared BoNT-A injections in addition to a comprehensive rehabilitation program vs rehabilitation alone, with no difference identified. 20…”