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Multilevel botulinum toxin type a as a treatment for spasticity in children with cerebral palsy: a retrospective
Ece Unlu1, Alev Cevikol, Burcu Bal
1Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Physical Medicine and Rehabilitation - Ankara, Turkey.
Insights
Multilevel botulinum toxin type A (BTX-A) injections in children with cerebral palsy significantly improved motor function for six months. While spasticity reduction was temporary, gross motor function showed lasting gains.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a leading cause of childhood physical disability.
- Spasticity is a common and disabling symptom in children with CP.
- Botulinum toxin type A (BTX-A) injections are a recognized treatment for focal spasticity in CP.
Purpose of the Study:
- To evaluate the impact of multilevel lower extremity BTX-A injections on gross motor function and functional status in children with cerebral palsy.
- To assess changes in spasticity, motor function, and functional classification following treatment.
Main Methods:
- Retrospective analysis of 71 children with cerebral palsy (mean age 6.7 years).
- Spasticity assessed using Ashworth and Tardieu scales.
- Motor function measured by Gross Motor Function Measure (GMFM-88).
- Functional status classified using Gross Motor Function Classification System (GMFCS).
- Multilevel BTX-A injections administered under sedation with electrostimulation guidance.
Main Results:
- Significant reduction in spasticity scores (Ashworth, Tardieu) at 3 months, but not sustained at 6 months.
- Significant improvement in GMFM-88 scores observed at both 3 and 6 months.
- No significant changes noted in GMFCS levels at 3 or 6 months.
Conclusions:
- A single session of multilevel BTX-A injections can effectively reduce spasticity in children with cerebral palsy.
- These injections lead to significant improvements in gross motor function, which are sustained for at least six months.
- BTX-A treatment offers a valuable therapeutic option for enhancing motor capabilities in pediatric CP patients.
Introduction:
Cerebral palsy is the most common cause of physical disability in children. Spasticity is a disabling clinical symptom that is prevalent among patients suffering from cerebral palsy. The treatment of spasticity with botulinum toxin type A (BTX-A) is a well-established option in the interdisciplinary management of spasticity, providing focal reductions in muscle tone in cerebral palsy patients.
Objective:
The aim of this retrospective study was to describe the effect of multilevel BTX-A injections in the lower extremities, focusing mainly on gross motor function and functional status in cerebral palsy patients.
Methods:
Data from 71 cerebral palsy patients (64% male, 36% female, mean age 6.7 +/-3.2 years) were analyzed retrospectively. We used the Ashworth and Tardieu scales to evaluate the degree of spasticity. Motor function was measured by the Gross Motor Function Measure (GMFM-88), and functional status was classified by the Gross Motor Function Classification System (GMFCS I-V). Multilevel BTX-A injections were applied after sedation and with electrostimulation guidance. The evaluations were repeated every three months, and the patients were followed for six months.
Results:
We found that the Ashworth and Tardieu scores decreased significantly at the three-month evaluation (p<0.05) but not at the six-month evaluation (p>0.05). Although the improvement in spasticity was not maintained at the six-month evaluation, GMFM-88 scores increased significantly at the three- and six-month assessments. GMFSC levels showed no change in the three- and six-month assessments.
Conclusion:
We believe that a single multilevel BTX-A injection reduces spasticity and improves motor function in children with cerebral palsy.
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