The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna

Małgorzata Malinowska-Matuszewska, Małgorzata Kulesa, Antoni Czupryna – The efficacy of treatment with botulinum toxin type A in children with dynamic contractures of lower limbs in the management of cerebral palsy. Fizjoterapia Polska 2007; 7(1); 38-44

Abstract

Background. The efficacy of botulinum toxin type A (BTX-A) in the management of cerebral palsy was determined in the lower limb. Material and methods. The study was carried out on 51 children with cerebral palsy aged 2-17 years (mean age 8 years and 6 months). The patients were undergoing treatment with BTX-A to reduce spasticity and alleviate dynamic contractures. Between one and four target muscles were selected according to functional goals (improving the gait pattern, increasing the range of motion at joints) and biomechanical assessments and were injected at multiple sites with BTX-A. The patients were evaluated at baseline and at 3 and 12 weeks post-injection. Parameters evaluated comprised Joint Range of Motion (ROM), Modified Ashworth Scale (MAS), Modified Physician Rating Scale (MPRS), Gross Motor Function Measure (GMFM) and Global Clinical Impression (GCI). Patterns of gait were monitored by VHS registration. Results. The statistical tests showed a significant (one degree) improvement over baseline at 3 weeks after the first injection (p<0.05) in MAS, MPRS, and GCI. A deterioration of MPRS and joint range of motion was observed at 12 weeks after the first dose and before the second dose (p<0.01). Two patients started to walk without mobility devices after the BTX-A treatment. The outcomes were worse in the five patients who did not perform the required rehabilitation programme after the BTX-A treatment. Conclusions. The use of BTX-A is indicated in children with diplegia and spastic hemiplegia to improve locomotor ability, and in tetraplegic children to facilitate nursing care and enable the patients to assume a standing position.

Słowa kluczowe:
spasticity, cerebral palsy, botulinum toxin type A (BTX-A), lower limbs
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