Botulinumtoxin A treatment in toddlers with cerebral palsy

• Published in: Acta Paediatrica Vol. 99; no. 8; pp. 1156 - 1162
• Main Authors: Tedroff, K, Löwing, K, Haglund-Åkerlind, Y, Gutierrez-Farewik, EM, Forssberg, H
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-08-2010; Blackwell
• Subjects: Biological and medical sciences; Botulinum toxin A; Cerebral palsy; Contracture; Dermatologi och venerologi, klinisk genetik, invärtesmedicin; Dermatology and venerology,clinical genetics, internal medicine; Gait; General aspects; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Internal medicine; Invärtesmedicin; Long term; Medical sciences; MEDICIN; MEDICINE; Nervous system (semeiology, syndromes); Neurology; Paediatric medicine; Pediatrisk medicin; Human; Botulinum toxin A; Cerebral palsy; Pediatrics; Nervous system diseases; Gait; Enzyme; Metalloendopeptidases; Infant; Long term; Contracture; Cerebral disorder; Peptidases; Bontoxilysin; Treatment; Central nervous system disease; Hydrolases; Child
• ISSN: 0803-5253; 1651-2227; 1651-2227
• DOI: 10.1111/j.1651-2227.2010.01767.x

Aims:  In this study the aim was to evaluate the effect of botulinum toxin A (BoNT‐A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP).
Method:  Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT‐A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait‐analysis was performed at 5 years of age.
Results:  Plantarflexor muscle tone in the BoNT‐A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change‐score in knee‐flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT‐A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM‐66 or PEDI.
Conclusion:  Early treatment of BoNT‐A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.