Botulinum Toxin for Spasticity in Children With Cerebral Palsy: A Comprehensive Evaluation

Abstract

BACKGROUND-Spasticity is a prevalent disabling clinical symptom for children with cerebral palsy. Treatment of spasticity with botulinum toxin in children with cerebral palsy was first reported in 1993. Botulinum toxin provides a focal, controlled muscle weakness with reduction in spasticity. Interpretation of the literature is difficult due to the paucity of reliable measures of spasticity and challenges with measuring meaningful functional changes in children with disabilities.

Estimation of botulinum toxin type A efficacy on spasticity and functional outcome in children with spastic cerebral palsy

“…The results correlate with previous similar reports [21][22][23] . In these studies measurement of spasticity, including PMR, was done using the method and in the same way as in our study by MAS, and such parameter of the evaluated study sample was presented as mean, referring to non qualitative characteristics.…”

Botulinum toxin type A in the treatment of lower-limb spasticity in children with cerebral palsy

“…The physiological and mechanical effects of BoNT/A treatment are genuine and measurable in patients with spastic diplegia. However, these effects may not trigger a major change in function or change in the patient's or his/her parents' perception of function and thus not be recorded as a significant improvement in the patient's family and social life 22 .…”

“…A critical assessment of the predictive factors for a good therapeutic result, the physiopathology of spasticity, the mechanism of action of BoNT/A and an understanding that a child's organism is undergoing constant change are directly related to the key elements for effective therapy using BoNT/A, namely, suitably chosen patients; clearly defined treatment objectives as a result of discussion with the patient and his/her family; and an effective long-term strategy for managing the changes that take place in a child with CP who is in a growth and development phase 21,22 .…”

“…Bjornson et al 22 showed that the family members' expectations for the therapy were far removed from the actual effects of the treatment and that they had difficulty appreciating the benefits of the treatment. on the other hand, patients and family members understand and rarely complain about the adverse effects of the treatment.…”

Practice Parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review)

“…20 -22 In one study, spasticity was significantly reduced by electromechanical measure but not by AS. 23 Spasticity was reduced at 2 weeks ( p ϭ 0.0001), 24 4 weeks ( p Ͻ 0.001), 25 and 3 months ( p ϭ 0.01) 16 after treatment. One Class I study provided information regarding the degree of spasticity improvement.…”