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Managing spasticity in pediatric cerebral palsy using a very low dose of botulinum toxin type A: preliminary report
1Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand.
Insights
Very low doses of botulinum toxin type A (BTX-A) combined with rehabilitation therapy significantly reduced spasticity and improved gait in children with cerebral palsy, with lasting benefits observed for up to 20 months.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by motor impairments, including spasticity.
- Spasticity in CP can significantly impact gait and functional mobility.
- Current treatment strategies often involve a combination of therapies to manage symptoms.
Purpose of the Study:
- To evaluate the efficacy of very low doses of botulinum toxin type A (BTX-A) in conjunction with rehabilitation therapy.
- To assess the impact of this combined approach on spasticity and gait in children with cerebral palsy.
Main Methods:
- A study involving ten trainable, ambulatory children with spastic diplegic or hemiplegic cerebral palsy.
- Participants received either 0.5 or 1.0 units/kg/muscle of BTX-A based on modified Ashworth scale scores.
- Post-injection, all patients underwent rehabilitation therapy and utilized orthoses for walking.
Main Results:
- Significant improvements in modified Ashworth scores (spasticity) and gait were observed within 72 hours post-injection.
- The beneficial effects of the treatment persisted for 10 to 12 months in most participants.
- Three patients experienced sustained benefits for at least 20 months.
Conclusions:
- Very low-dose BTX-A, when combined with rehabilitation therapy, offers a long-lasting reduction in spasticity.
- This therapeutic strategy leads to sustained improvements in gait for children with cerebral palsy.
- The findings support BTX-A as a valuable adjunct to conventional rehabilitation in managing CP-related spasticity.
Objective:
To determine if very low doses of botulinum toxin type A (BTX-A) could reduce spasticity and improve gait in cerebral palsied children when combined with rehabilitation therapy.
Design:
Ten trainable (IQ > 80), ambulatory, spastic diplegic or hemiplegic cerebral palsied children, with no fixed contractures in at least one limb, were selected for the study. Patients with a score of 3 on a modified Ashworth scale received 0.5 units of BTX-A/kg/muscle. Patients with an Ashworth score of 4 received 1.0 BTX-A/kg/muscle. After BTX-A injection, all patients received rehabilitation therapy and plastic ankle and foot orthoses for walking.
Results:
Both groups exhibited improvement in Ashworth score and in gait within 72 hr of injection with botulinum toxin. Beneficial effects persisted for 10 to 12 mo in most patients, with three patients exhibiting benefits for at least 20 mo.
Conclusions:
The results of the present study indicate that a very low dose of botulinum toxin type A combined with'rehabilitation therapy resulted in a long-lasting decrease in spasticity and an improvement in gait in children with cerebral palsy.