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Determinant Factors for The Efficacy of Botulinum Toxin Injections on Lower Limb Function in Cerebral Palsy: Two Year
Julide Oncu Alptekin1, Aylin Ayyildiz2, Selda Ciftci Inceoglu1
1Department of Physical Medicine and Rehabilitation, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
Insights
Long-term botulinum toxin-A (BTX-A) treatment improved motor and gait functions in children with spastic cerebral palsy (CP). Key predictors of success include young age, baseline function, and treatment frequency.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Movement Disorders
Background:
- Spastic cerebral palsy (CP) significantly impacts motor and gait functions in children.
- Botulinum toxin-A (BTX-A) is a common treatment for spasticity in CP.
- Predicting treatment response is crucial for optimizing care.
Purpose of the Study:
- To identify factors that predict the effectiveness of long-term intramuscular BTX-A treatment.
- To evaluate the impact of BTX-A on motor and gait functions in pediatric CP.
- To analyze predictors for motor and gait score improvements.
Main Methods:
- A cohort of 200 children with CP received long-term BTX-A treatment, focusing on lower limbs.
- Follow-up extended over two years, with outcomes compared to baseline.
- Spasticity (Modified Ashworth Scale), motor function (GMFCS), and gait (OGS) were assessed.
Main Results:
- BTX-A treatment led to significant improvements in spasticity, GMFCS, and OGS scores after two years.
- Predictors for motor score improvement included younger age, higher baseline OGS, independent walking, baseline GMFCS, and hemiplegia.
- Gait score improvement was determined by the number of injections and higher baseline GMFCS.
Conclusions:
- Younger age, independent ambulation, baseline GMFCS, higher baseline OGS, hemiplegic CP type, and multiple BTX-A injections predict treatment efficacy.
- These findings aid in tailoring BTX-A therapy for children with spastic CP.
- Understanding predictors can optimize functional outcomes in pediatric CP management.
Objectives:
This study evaluated the factors predicting the effect of long-term intramuscular botulinum toxin-A (BTX-A) treatment on motor and gait functions in children with spastic cerebral palsy (CP).
Methods:
Two hundred children diagnosed with CP were treated with BTX-A, with particular attention given to the lower limbs. The children were followed up for over two years. The severity of spasticity was evaluated using the Modified Ashworth Scale. The Gross Motor Function Classification System (GMFCS) and Observational Gait Scale (OGS) were used to assess changes in motor and gait function scores. Outcomes at the end of two years were compared with baseline values.
Results:
After two years, the severity of spasticity and the GMFCS and OGS scores improved with BTX-A treatment. The most important factors predicting improvement in motor scores after treatment were young age, high baseline OGS scores, independent walking, baseline GMFCS scores, and hemiplegia. The determinant factors for improvement in gait scores were the number of injections and a high baseline GMFCS level.
Conclusion:
The predictors of the efficacy of BTX-A treatment on gait and motor function were young age, independent ambulatory status, gross motor function level, high baseline gait scores, hemiplegic type of CP, and multiple BTX-A injections.
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