Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy

Abstract

This study evaluated the effects of multilevel botulinum toxin type A (BTX-A) treatments on the gait pattern of children with spastic cerebral palsy (Gross Motor Function Classification System Levels I-III). In this nested case-control design, 30 children (mean age 6y 11mo [SD 1y 5mo]; 21 males, nine females; 19 with hemiplegia, 11 with diplegia) were treated according to best practice guidelines in paediatric orthopaedics, including BTX-A injections. A matched control group of 30 children (mean age 7y 8mo [SD 1y 10mo]; 13 males, 17 females; 19 with hemiplegia, 11 with diplegia) were treated identically, but without BTX-A. Motor development status at 5 to 10 years of age was assessed by means of three-dimensional gait analysis at a mean time of 1 year 10 months (SD 10mo) after the last BTX-A treatment. The control group showed a significantly more pronounced pathological gait pattern than the BTX-A group. Major differences were found for pelvic anterior tilt, maximum hip and knee extension, and internal hip rotation. These results provide evidence for a prolonged effect of BTX-A and suggest that BTX-A injections, in combination with common conservative treatment options, result in a gait pattern that is less defined by secondary problems (e.g. bony deformities) at 5 to 10 years of age, minimizing the need for complex surgery at a later age and enhancing quality of life.

Factors Influencing the Gross Motor Outcome of Intensive Therapy in Children with Cerebral Palsy and Developmental Delay

“…This improves gait pattern and function by reducing spasticity in ambulatory children with spastic CP (212223). Unexpectedly, botulinum toxin injection into the muscles of the lower extremities did not have any additional effect on GMFM score improvement among the spastic CP children included in the present study.…”

Musculoskeletal Complications of Neuromuscular Disease in Children

“…Shortterm improvements in functional outcomes (gait, Gross Motor Function Measure, and clinical examination) using botulinum toxin injections have been reported, but evidence is limited regarding the effect of botulinum toxin treatment on the development of bony deformity. In a nested case-control design, Desloovere and colleagues [87] reported an improved gait pattern characterized by fewer contractures at the level of the hip, knee, and ankle and decreased internal hip rotation at initial contact, toe-off, and mid-swing in children who had undergone multilevel botulinum A treatments. Botulinum injections were started at a young age and combined with common conservative treatment options.…”

Pelvic kinematics and their relationship to gait type in hemiplegic cerebral palsy

“…This also resulted in an increased range of pelvic tilt in these children. More recently, Desloovere and colleagues [9] documented an increased anterior pelvic tilt of 22.58 in a group of children with hemiplegia (n = 11) and diplegia (n = 19) who had not had any previous intervention. Although quantitative information from their normative database is not reported, their analysis infers a significant difference between their typically developed population and CP group.…”