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Parameters for predicting favorable responses to botulinum toxin in children with cerebral palsy
Aviva Fattal-Valevski1, Nir Giladi, Dafna Domanievitz
1Institute for Child Development, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. afatal@post.tau.ac.il
Insights
Predicting favorable outcomes for children with cerebral palsy receiving botulinum toxin A injections is possible. Higher spasticity and lower function scores predict a good response to this treatment.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Biomedical Engineering
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder affecting movement and posture.
- Botulinum toxin A injections are used to manage spasticity in children with CP.
- Predictive markers for treatment response are needed to optimize patient selection.
Purpose of the Study:
- To identify clinical markers that predict a favorable outcome of botulinum toxin A (BoNT-A) injections in the lower extremities of children with CP.
- To guide patient selection and manage expectations for BoNT-A therapy.
Main Methods:
- A prospective study involving 26 children with hemiplegic or diplegic CP.
- Clinical assessments included the Gross Motor Function Measure (GMFM), Modified Ashworth Scale (MAS), and range of motion.
- Treatment response was categorized using a parent questionnaire.
Main Results:
- Children with higher pre-injection MAS scores (indicating greater spasticity) and lower GMFM scores (indicating lower function) were more likely to be good responders.
- Sixty-eight percent of good responders were nonindependent walkers, compared to 14% of poor responders.
- No significant differences were found in age, CP type, or BoNT-A dose between responders.
Conclusions:
- Increased muscle tone (spasticity), lower gross motor function, and nonindependent ambulatory status are predictive of a favorable response to lower-extremity BoNT-A injections in children with CP.
- These markers can aid clinicians in selecting appropriate candidates for BoNT-A therapy.
- Setting realistic expectations for treatment outcomes is crucial for managing patient and family satisfaction.
Abstract:
We sought markers for predicting a favorable outcome of botulinum toxin A injected to the lower-extremity muscles of 26 children with hemiplegic or diplegic cerebral palsy. Clinical assessment preceding and 1 month following injection included gross motor function measure, a modified Ashworth scale, and evaluation of range of motion of knee extension and ankle dorsiflexion. Response to treatment was classified based on a parent questionnaire. The 19 children (73%) considered by their parents as being good responders were compared to the 7 (27%) considered as being poor responders. In the good responders, the preinjection Ashworth scale (spasticity) was significantly higher (P < .05) and gross motor function measure scores (function) were lower (P < .05). Sixty-eight percent of the good responders were nonindependent walkers compared to 14% of the poor responders (P < .05). There were no differences in age, type of cerebral palsy, and dose of injection. An Ashworth scale indicating increased muscle tone, lower gross motor function measure scores, and nonindependent ambulatory status were predictive for a favorable response to botulinum toxin A injections and can guide patient selection and expectations of treatment outcome.