Spasticity management with botulinum toxin A in children with Cerebral palsy
SPASTICITY MANAGEMENT WITH BOTULINUM TOXIN A IN CHILDREN WITH CEREBRAL PALSY: FUNCTIONAL OUTCOMES WITHIN THE FIRST POST-TREATMENT YEAR
H. N. SKOUTELI, G. STYLIANIDOU, S. VRETTOS, L. LOIZOU,
CEREBRAL PALSY CLINIC “MAKARIOS” HOSPITAL, NICOSIA, CYPRUS
Recent studies show that Botulinum Toxin A (BtA) intramuscular injections may reduce spasticity and prevent deformities in children with Cerebral Palsy (CP). However the functional benefits from this method have not yet been decided.
In this prospective study we analyse the motor outcomes of CP children within the first year following BtA injections.
Thirty eight children (mean age: 4,5 yrs) with spastic CP of varying severity were injected with BtA in selected lower extremities’ muscles. The goal was to improve motor function and to promote independence, according to the child’s baseline status. Clinical team examinations at baseline and in months (mos) 1,2,3,6,9,12 thereafter included spasticity measurement by Ashworth scale (AS), Joint Passive Range of Motion (PROM) estimation by goniometry, Gross Motor Function Measure test scoring and video recordings.
Most children 28/38 (diplegia 21/23, hemiplegia 5/5, tetraplegia 3/10) showed significant AS/PROM improvement at 3mos with functional gains extending over 6 mos. (Good responders 73,5%). Among them 5 diplegic, ex-premies (3-4yrs) continued to improve over 9mos (Optimal responders 13%). Minimal AS/PROM, 3mos changes with no significant functional benefits were encountered in 10 patients (tetraplegia 7/10, diplegia 2/23) with mental retardation and seizures (Minimal responders 26,3%).
BtA injections can have a prolonged beneficial effect on motor outcomes in the majority of CP children. Realistic selection criteria, set by a multidisciplinary team considering the severity of CP and associated problems are mandatory.