Effectiveness of Multilevel Botulinum Toxin A Injection with Integrated Treatment Program on Spasticity Reduction in Non-Ambulatory Young Children with Cerebral Palsy

Abstract

Objective: The aim of the present study was to evaluate the effectiveness of multilevel Botulinum Toxin A (BTX-A) injection, as part of an integrated approach, for the treatment of spasticity in non-ambulatory young children with diplegic cerebral palsy (CP). Subjects and Methods: Seventeen non-ambulatory patients aged 4–8 years with diplegic CP (Gross Motor Function Classification System [GMFCS] level IV) were evaluated before and at 1st, 3rd, and 6th months after BTX-A injection. The effect of BTX-A on spasticity of gastrocnemius and hamstring muscles was assessed using the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). The velocity-dependent properties of spastic muscle as both slow (R2) and fast (R1) stretches were evaluated in MTS. Results: A statistically significant improvement was observed in R1 angles of gastrocnemius and hamstring muscles at 1st and 3rd months after BTX-A injection in non-ambulatory young children with CP. Statistically significant improvement was found in MAS of gastrocnemius and hamstring muscles and R2 angles of knee and ankle joint after 1st month of BTX-A injection. Conclusion: Multilevel BTX-A injection, as part of an integrated approach, can be used for focal treatment of spasticity, especially of hamstring and gastrocnemius muscles, in non-ambulatory young children with CP GMFCS level IV.

Botulinum Toxin-A Injection for Hip Adductor Spasticity in Children with Cerebral Palsy: A Retrospective Study

“…Other studies have shown that BoNT-A injection significantly improved MAS and GMFCS values in CP patients. [20][21][22] In addition to significant improvement in hip adductor spasticity, unlike previous studies, we found significant improvements in measurements of the distance between the knees after the treatment compared to before treatment both knee flexion and extension, and, both quickly and slowly.…”

Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis

“…During this age period, it is the optimal time to start BoNT-A due to flexible gait patterns and gross motor function [38]. The BoNT-A dosage from our review is 3 U/Kg/body weight, which is quite compatible with the common use of 4-8 U/kg/body [38], and multilevel BoNT-A 2 to 29 U/kg/body weight [38] for severe spasticity with multiple contractures [39]. In addition, our study points out that the BoNT-A plus physiotherapy could significantly increase the passive ankle dorsiflexion when compared to the physiotherapy alone, but the previous study did not estimate this effect.…”

Prediction Model for Identifying Computational Phenotypes of Children with Cerebral Palsy Needing Neurotoxin Treatments

“…Since the nineties, botulinum treatment of spastic equines foot has been recommended [ 30 , 31 , 32 ]. In young children with CP and high GMFCS, multilevel injection of BTX can be used for focal treatment of spasticity, particularly for the lower extremity [ 30 ].…”

“…Injection and distal injection were significantly related to a more significant gain in gross motor function in the younger age group [ 30 ]. The functional hindrance of the spastic equines foot is often the initial obstacle noted by parents and specialists.…”

“…In CP children with upper and lower limb spasticity, there is increasing evidence of the time-limited beneficial effect of BTX in decreasing muscle tone. Decreased muscle tone in the lower limbs may translate into improved ambulation in children with CP with spastic equino-varus [ 30 ].…”