Use of Botulinum toxin type a in children with Spastic Cerebral Palsy

Background: Cerebral palsy (CP) is one of the most common causes of activity limitation in children. Botulinum toxin (BoNT-A) is relatively recent addition to the available medical interventions for children with cerebral palsy. Objective: to determine possible effects of injections of BoNT-A on muscle tone, passive range of motion in lower extremity and gross motor function in children with spastic CP. Methods: Forty one children with spastic CP were included in this prospective study. They received for the first time treatment with botulinum toxin type A in the period 2003-2008. Before and after the treatment with BoNT-A they were evaluated: passive range of joint motion (PROM) of low extremity, spasticity using Modified Ashworth Scale (MAS) and individualized therapeutic goals were planned using the Goal Attainment Scale (GAS). Results: PROM-abduction in hips was significantly improved two weeks, one and half, three and five months after the treatment. Knee-popliteal angle unilateral and polpiteal angle bilateral were significantly improved two weeks, one and half, three and five months after the treatment. PROM-dorsiflexion of ankle with extended knee left was significantly higher after 2 weeks and 3 months compared with pretreatment. PROM-dorsiflexion of ankle with knee flexion at 90 was significantly higher after 3 months (right) and after 1.5 and 3 months (left) compared with pretreatment. MAS of adductors was significantly decreased two weeks, one and half and three months after the treatment. After the treatment all mean values of MAS were lower compared with baseline values. Approximately 85% of patients achieved the expecting therapeutic goals according to GAS after the 5 months of treatment with BoNT-A. Conclusions: BoNT-A injections should always be used as an adjunctive treatment to physiotherapy, occupational therapy and orthotic management. In combination with post-injection physiotherapy this treatment could provide long-term benefits.