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Medium-term functional benefits in children with cerebral palsy treated with botulinum toxin type A: 1-year follow-up
M Linder1, G Schindler, U Michaelis
1Department of Neuropaediatrics and Muscle Disorders, Children's University Hospital, Freiburg, Germany.
Insights
Botulinum toxin type A (BTX-A) injections improved gross motor function in children with spastic cerebral palsy over one year. This treatment also enhanced joint mobility and reduced spasticity, particularly in younger, moderately affected children.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Movement Disorders
Background:
- Spastic cerebral palsy (CP) significantly impacts motor function and quality of life.
- Intramuscular botulinum toxin type A (BTX-A) is established for short-term spasticity management in CP.
- Long-term efficacy data for repeated BTX-A injections in pediatric CP are limited.
Purpose of the Study:
- To prospectively evaluate the 1-year functional outcomes of repeated BTX-A injections in children with spastic CP.
- To assess the impact of BTX-A on gross motor function using the Gross Motor Function Measure (GMFM).
- To analyze local effects on spasticity and joint mobility.
Main Methods:
- Open-label, prospective study involving 25 children (1.5–15.5 years) with spastic CP.
- BTX-A injections administered for adductor spasm (n=12) or pes equinus (n=13).
- Evaluations included passive range of motion, modified Ashworth Scale, and GMFM scores at baseline and 12 months.
Main Results:
- Significant improvements in joint mobility and reduced spasticity (P < 0.01) compared to baseline.
- Median 6% gain in GMFM total and goal scores after 12 months (P < 0.001).
- Greatest GMFM score increases observed in younger and moderately impaired children (GMFCS Level III).
Conclusions:
- One year of repeated BTX-A treatment significantly improved gross motor function in children with spastic CP.
- BTX-A effectively reduces spasticity and enhances joint mobility, contributing to functional gains.
- Further research is needed to differentiate BTX-A's specific contribution from the natural course of motor development.
Abstract:
One of the main goals when treating spasticity is to relieve pain and improve function. Intramuscular injection of botulinum toxin type A (BTX-A) has gained widespread acceptance in the treatment of spastic cerebral palsy. Several studies have clearly shown the short-term functional benefit of BTX-A treatment. Information is limited, however, on the efficacy of medium and long-term regimens, using repeated injection of BTX-A. The aim of the present open-label, prospective study was to evaluate functional outcome in children with spastic cerebral palsy after 1 year of treatment with BTX-A, using the Gross Motor Function Measure (GMFM) as a validated outcome measure. Patients (n=25, age 1.5--15.5 years) were treated with BTX-A for adductor spasm (n=12) or pes equinus (n=13). The local effect was evaluated using passive range of motion and modified Ashworth Scale. Apart from a significant improvement in joint mobility and reduction of spasticity compared to pretreatment values (P < 0.01), we demonstrated a significant improvement of gross motor function after 12 months of treatment, with a median gain of 6% in total and goal scores (P < 0.001). An increase in GMFM scores was particularly evident in younger and moderately impaired children (Gross Motor Function Classification System level III). Whether the observed improvement in gross motor function in children with cerebral palsy is specifically related to therapy with BTX-A or represents at least in part the natural course of motor development still needs clarification.