Botulinum toxin A in hamstring spasticity

Corry, Ian S.; Cosgrove, Aidan; Duffy, C.M.; Taylor, T C; Graham, H. Kerr

doi:10.1016/s0966-6362(99)00037-5

Cited by 98 publications

(60 citation statements)

References 11 publications

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“…Considerable data have now been gathered from many randomized and placebo-controlled studies to support the use of BTX-A for this condition [1][2][3][4][5][6][7]. Functional gains, however, have been more difficult to demonstrate [8].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effect of Repeated Injections of Botulinum Toxin in Children With Cerebral Palsy – A Prospective Study

Fattal‐Valevski¹,

Hayek²,

Domenievitz³

et al. 2006

Neuropediatrics

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Purpose To prospectively evaluate long-term effects of repeated botulinum toxin A (BTX-A) injections in children with cerebral palsy (CP). Methods Repeated injections of BTX-A were offered to children with CP, according to clinical indications, for a maximum of four injections within a period of two years. Injections were administered into lower extremity muscles of 26 consecutive children (age 3.7 ± 1.2 years, 16 boys) with hemiplegic or diplegic CP. Clinical assessments before and one month following each injection included a gross motor function measure (GMFM), a modified Ashworth scale, and range-of-motion of knee extension and ankle dorsiflexion. Results Twelve children received two injections, six received three injections, five received one injection, and three received four injections. The most common reason for discontinuing treatment was the need for orthopedic surgery (n = 17). A long-term effect was demonstrated by a significant increase of the GMFM score before the first injection compared with the last injection for each patient (P \ 0.0001). There was no comparable change in the muscle tone or range-of-motion. The mean rate of GMFM change during the study was significantly higher than literature norms for CP children (13.2 vs. 5.37 per year, respectively, P \ 0.01). The increase of the GMFM score before and one-month after injection (short-term effect) was significantly higher after the first injection than after the last injection (P \ 0.05). Similar results were found for the Ashworth scale and popliteal angle. Conclusions Botulinum toxin A injections have a longterm effect on gross motor function in children with CP even though the effect on muscle tone is short-term. The effect apparently declines with repeated injections, with most children benefitting from 2 to 3 injections.

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Section: Introductionmentioning

confidence: 99%

Long-Term Effect of Repeated Injections of Botulinum Toxin in Children With Cerebral Palsy – A Prospective Study

Fattal‐Valevski¹,

Hayek²,

Domenievitz³

et al. 2006

Neuropediatrics

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“…Botulinum toxin A injection should be used in carefully selected patients. Corry et al (21) showed that anterior pelvic tilt increased after botulinum toxin A injection to hamstring muscles in 10 CP patients with crouch gait. Care should be taken not to cause isolated hamstring weakness.…”

Section: Management Of Knee Flexion Deformitiesmentioning

confidence: 99%

Assessment of the Hip and Knee Flexion Contractures in Cerebral Palsy Patients with Crouch Gait

Bilgili¹,

Temelli²,

Akalan³

2012

JAREM

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The knee is the most affected joint in children with cerebral palsy. Flexion contracture of the knee is the cause of the crouch gait pattern, instability in stance phase of gait, and difficulties during standing and sitting, and other daily living activities. Hip flexion contracture in crouch gait is mostly compensation of the knee flexion contracture and ankle equines. The psoas muscle is the primary reason for the hip flexion contracture and is known to be associated with increased anterior pelvic tilt, crouching gait, hip instability and lumbar lordosis. Children with cerebral palsy may even give up walking due to the high energy demand in the adult period. The purpose of this article is to review the causes of the knee and hip flexion contractures, clinical evaluations, and treatment principles in children with cerebral palsy. The biomechanical reasons of knee and hip flexion deformity are discussed in detail in the light of previous studies and gait analysis data. (JAREM 2012; 2: 33-7) Key Words: Cerebral palsy, child, contracture, gait, hip joint, knee joint, muscle, skeletal, tendons ÖZET Beyin felcinde en çok etkilenen eklem diz eklemidir. Diz fleksiyon kontraktürü, çömelme pozisyonunda yürümeye, basma fazında stabilite kaybına, ayakta durma ve oturmada ve günlük yaşam aktivitelerinde zorluklara yol açar. Kalça fleksiyon kontraktürü yürüyüş sırasındaki çömelmedeki kalça fleksiyon kontraktürü sıklıkla diz fleksiyonu ve ayak bileği ekinusunun kompansasyonu içindir. Kalça fleksiyon kontraktürünün primer sebebi ise psoas kasıdır ve neticesinde artmış anterior pelvik tilt, çömelme yürüyüşü, kalça instabilitesi ve lomber lordozla ilişkili olduğu bilinmektedir. Bu çocuklar ileri yaşlarda, yüksek enerji gerektirdiği için yürümeden bile vazgeçebilirler. Bu yazıda, beyin felçli çocuklarda diz fleksiyon kontraktürlerinin nedenleri, klinik değerlendirmeler ve tedavi prensipleri gözden geçirildi. Ayrıca, yapılan çalışmalar ve yürüme analizi verileri ışığında diz fleksiyon kontraktürünün biyomekaniksel nedenleri ayrıntılı olarak tartışıldı. (JAREM 2012; 2: 33-7)

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“…38,40 If this fails to correct an equinovarus deformity fully, tibialis posterior can be injected or, if more appropriate, tibialis anterior. Similarly, overactivity of the hamstrings can be improved by injection of BTX-A and the response to injection may also help to predict the results of hamstring lengthening 41 or adductor tenotomy. Injection of the hip flexors is more technically demanding and may require ultrasound guidance for the accurate localisation of the muscle, and hence the toxin.…”

Section: Cerebral Palsymentioning

confidence: 99%