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Effect of Botulinum Toxin on Equinus Foot Deformity in Cerebral Palsy Patients: A Systematic Review and Network
Mohamed Fathi1, Ahmed S Hussein2, Shrouk M Elghazaly3
1Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Botulinum toxin A (BTX-A) effectively reduces spasticity in children with cerebral palsy (CP) and equinus foot deformity. BTX-A alone demonstrated superior outcomes compared to combination therapy with serial casting.
Area of Science:
- Neurology
- Orthopedics
- Physical Medicine and Rehabilitation
Background:
- Cerebral palsy (CP) is a neurological disorder impacting movement and posture in children.
- Equinus foot deformity is a common complication of CP, limiting range of motion.
- Investigating the efficacy of botulinum toxin (BTX) products, with or without serial casting, is crucial for managing CP-related spasticity.
Purpose of the Study:
- To compare the efficacy of different botulinum toxin (BTX) products for treating equinus foot deformity in cerebral palsy (CP).
- To evaluate the impact of BTX treatment, with or without serial casting, on muscle spasticity and range of motion in CP patients.
- To determine the optimal BTX treatment strategy for improving motor function in children with CP.
Main Methods:
- A systematic literature review was conducted across PubMed, Scopus, Web of Science, and GHL databases.
- Network meta-analysis was employed to analyze extracted data using R software (version 3.5.0).
- Efficacy was assessed using the Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM), Modified Tardieu Scale (MTS), and passive range of motion (PROM).
Main Results:
- Botulinum toxin A (BTX-A) showed superiority over placebo and BTX-A plus immediate casting in reducing spasticity (MAS).
- Neuronox demonstrated better outcomes in motor function (GMFM) at 3 and 6 months compared to BTX-A.
- BTX-A alone was superior to BTX-A plus immediate casting for spasticity (MAS, MTS) and range of motion (PROM).
Conclusions:
- BTX-A demonstrated the best overall performance across physician ratings, spasticity measures (MAS, MTS), and range of motion (PROM).
- BTX-A monotherapy proved more effective than BTX-A combined with immediate serial casting for equinus foot deformity in CP.
- The findings support BTX-A as a primary treatment option, with further research needed to compare specific BTX products comprehensively.
Background:
Cerebral palsy (CP) is a brain disorder that affects the development, movement and posture leading to limitation of Range of Movement (ROM) in the growing children. CP leads to deformities such as equinus foot deformity. We aim to investigate the efficacy of different botulinum toxin (BTX) products with or without serial casting in reducing the muscle spasticity in equinus foot deformity in patients with CP.
Methods:
A systematic review of the literature was performed by searching different electronic databases. Pub- Med, Scopus, Web of Science (WOS), and GHL databases were used. We analyzed the extracted data by network meta-analysis method using the R software package (version 3.5.0).
Results:
Regarding Modified Ashworth score (MAS), BTX-A was superior compared to placebo and BTX-A plus immediate casting (MD = -0.39, 95% CI [-0.60; -0.18]) and (MD = -0.50, 95% CI [-0.98; -0.02]), respectively. Concerning growth motor function movement Classification System (GMFM), Neuronox ranked above at 3 months (MD = -1.60, 95% CI [-2.87; -0.33]) and at six months (MD = -1.90, 95% CI [-3.48; -0.32]) compared to BTX-A. Regarding the Modified Tardieu scale (MTS) with knee flexion, BTX-A was superior to BTX-A plus immediate casting (MD = 8.60, 95% CI [1.76; 15.44]). Concerning passive range of movement (PROM) with Knee flexion or extension at 3 months, BTX-A showed a significant improvement compared to BTX-A plus immediate casting.
Conclusion:
BTX-A ranked best on a physician rating scale (PRS), MAS, MTS with knee flexion and PROM (Knee flexion and extension) compared to Neuronox and Botulax. BTX-A alone was also better than BTX-A plus immediate casting.
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