Effectiveness of Multilevel Botulinum Toxin A Injection with Integrated Treatment Program on Spasticity Reduction in...

Area of Science:

• Pediatric Neurology
• Rehabilitation Medicine
• Movement Disorders

Background:

• Spasticity is a common challenge in children with diplegic cerebral palsy (CP), impacting motor function.
• Non-ambulatory children with CP, particularly those at GMFCS level IV, often experience significant muscle spasticity.
• Targeted interventions are crucial for managing spasticity and improving quality of life in this population.

Purpose of the Study:

• To assess the efficacy of multilevel Botulinum Toxin A (BTX-A) injections as part of an integrated treatment for spasticity.
• To evaluate the impact of BTX-A on specific muscle groups, namely gastrocnemius and hamstrings, in young children with CP.
• To determine the effectiveness of BTX-A in improving spasticity measures in non-ambulatory diplegic CP patients.

Main Methods:

• A study involving seventeen non-ambulatory children (aged 4-8 years) with diplegic CP (GMFCS level IV).
• Patients received multilevel BTX-A injections, with assessments conducted at baseline and at 1, 3, and 6 months post-injection.
• Spasticity was measured using the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS), evaluating both slow (R2) and fast (R1) stretch properties.

Main Results:

• Significant improvements in R1 (fast stretch) angles for gastrocnemius and hamstring muscles were observed at 1 and 3 months post-injection.
• The Modified Ashworth Scale (MAS) scores for gastrocnemius and hamstring muscles showed statistically significant improvement after 1 month.
• Improvements in R2 (slow stretch) angles for knee and ankle joints were noted from the 1st month onwards.

Conclusions:

• Multilevel BTX-A injections offer a viable focal treatment option for spasticity in non-ambulatory young children with CP (GMFCS level IV).
• The integrated approach utilizing BTX-A demonstrates effectiveness in managing spasticity, particularly in the hamstring and gastrocnemius muscles.
• BTX-A treatment contributes to improved muscle tone and joint range of motion, supporting functional gains in this pediatric population.