Botulinum toxin type A management of spasticity in the context of orthopaedic surgery for children with spastic cerebral palsy

Abstract

Cerebral palsy is the most common cause of physical disability affecting children in developed countries. Although cerebral palsy is, by definition, a 'static encephalopathy' the associated musculoskeletal pathology is progressive and current definitions are therefore somewhat inadequate. Understanding the stages of the musculoskeletal pathology is fundamental to understanding current management strategies, including spasticity management, strengthening programmes and deformity correction by orthopaedic surgery. In this review, a number of new management strategies are described, in which spasticity management by intramuscular injections of botulinum toxin type A and deformity correction, by orthopaedic surgery, are combined.

Musculoskeletal Aspects of Cerebral Palsy

“…[39][40][41] Spasticity is only one component of the upper motor neurone syndrome and not the most important in determining prognosis. 17,42 Weakness and loss of selective motor control are more important than spasticity and are more difficult to manage. Uncontrolled studies are subject to bias and controlled clinical trials are required to investigate efficacy.…”

Gait classification in children with cerebral palsy: A systematic review

“…They also speculated about interventions that would not be suitable for certain classification levels [15]. The Winters classification system is one of the most cited gait classifications in cerebral palsy and has been used in many outcome studies to define the study population [50,[56][57][58][59][60]. It has also been used by other researchers as the basis for developing new classifications [3,[10][11][12]54].…”

Muscle volume alterations in spastic muscles immediately following botulinum toxin type‐A treatment in children with cerebral palsy

“…9 However, generalised muscle weakness 5,10,11 and weakness in neighbouring non-targeted muscles 12,13 have been reported as undesirable effects of BoNT-A.…”