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Botulinum toxin in the management of the lower limb in cerebral palsy
A P Cosgrove1, I S Corry, H K Graham
1Department of Orthopaedic Surgery, Queen's University of Belfast, Northern Ireland.
Insights
Intramuscular botulinum toxin A injections effectively reduced muscle tone in children with cerebral palsy, improving their walking ability. These benefits often persisted even after the muscle-relaxing effects diminished.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) often involves dynamic lower-limb contractures impacting mobility.
- Spasticity in CP can significantly hinder a child's ability to position themselves and ambulate effectively.
Purpose of the Study:
- To evaluate the efficacy of intramuscular botulinum toxin A (BoNT-A) in treating dynamic lower-limb contractures in children with CP.
- To assess the impact of BoNT-A on spasticity, ambulatory status, and gait kinematics in pediatric CP patients.
Main Methods:
- Twenty-six children with CP received intramuscular injections of BoNT-A into spastic lower-limb muscles.
- Muscle tone, spasticity, and gait were assessed using clinical examination and gait analysis before and after treatment.
- Dosage ranged from 50-320 units per muscle group, with total doses of 100-400 units per child.
Main Results:
- No significant systemic side-effects were observed.
- Muscle tone reduction occurred in 25 out of 26 patients within three days, lasting two to four months.
- Significant improvements in ambulatory status and sagittal-plane gait kinematics were documented.
Conclusions:
- Intramuscular BoNT-A is a safe and effective treatment for dynamic lower-limb spasticity in children with CP.
- BoNT-A injections can lead to sustained improvements in motor function and gait, potentially beyond the duration of muscle tone reduction.
- This treatment offers a valuable therapeutic option for enhancing mobility and functional outcomes in pediatric CP.
Abstract:
The role of intramuscular botulinum toxin A in the treatment of 26 children with cerebral palsy was evaluated. The indication for injection was the presence of a dynamic contracture of lower-limb muscles interfering with positioning or walking. Spastic target muscles were identified by clinical examination and, in ambulant children, by gait analysis. Between 50 and 320 units of botulinum toxin were injected into each muscle group to a total dose of 100 to 400 units per child. The effects of injection were monitored by repeated clinical examination and gait analysis. There were no clinically detectable systemic side-effects, and all but one patient had a reduction in tone, which occurred within three days and persisted for two to four months. There were significant improvements in ambulatory status and in sagittal-plane kinematics. In some cases these gains persisted after the tone-reducing effects of the toxin had worn off.