The use of botulinum toxin therapy for lower-extremity spasticity in children with cerebral palsy

Abstract

<jats:p>✓ Hypertonicity is a leading cause of disability for children with cerebral palsy (CP). Botulinum toxin A (BTA) chemically denervates muscle tissue and is commonly used in the management of lower-extremity hypertonicity in children with CP because of its focal effects and wide safety margin. Randomized controlled trials have demonstrated that BTA injections in the ankle flexors, hamstrings, and adductors reduce spasticity and result in improved passive and active range of motion. In other studies, improvements in gait and measurements of functional outcome were found in appropriately selected children who had been injected with BTA. A multidisciplinary treatment approach that includes physical therapists, occupational therapists, orthotists, neurologists, physicians with expertise in performing botulinum toxin injections, orthopedic surgeons, and neurosurgeons is critical to optimize care in children with lower-extremity tone due to CP. In this paper, the authors propose treatment algorithms based on clinical presentation, detailed dosing, and technical information to optimize the treatment of these children. With a multidisciplinary approach, children with lower-extremity hypertonicity due to CP can experience improvements in muscle tone and function.</jats:p>

Sensory feedback to ankle plantar flexors is not exaggerated during gait in spastic hemiplegic children with cerebral palsy

“…It is therefore assumed that reduction of exaggerated reflex activity in ankle plantar flexors is necessary in order to prevent the plantar flexors from working against the dorsiflexors late in swing (Criswell et al 2006). Reduction of stretch reflex activity in the plantar flexors is thus assumed to help the child in lifting the foot late in swing and bringing the heel to the ground in early stance.…”

“…Indeed, this is often the reason for injection of botulinum toxin in the plantar flexor muscles of these children (Criswell et al 2006). However, as mentioned above, the children with CP did not show more soleus EMG activity in the swing phase than the control children and unload of the ankle plantar flexors did not produce any significant suppression of soleus EMG activity in the swing phase in the vast majority of the children.…”

“…In addition, it is generally believed that hyperexcitable stretch reflexes (spasticity according to the definition by Lance 1980) in ankle plantar flexors play a major role in creating premature overactivity in plantar flexors prior to heel strike (Winters et al 1987). As a consequence, antispastic treatment such as botulinum toxin A (Btx) is frequently administered in an effort to reduce plantar flexor hyperactivity and facilitate heel strike (Criswell et al 2006). However, in the last two decades several studies have questioned the functional significance of exaggerated stretch reflexes (Dietz et al 1981;Dietz and Sinkjaer 2007;Sinkjaer and Magnussen 1994).…”

Sexuality and Rehabilitation for Individuals with Cerebral Palsy

“…It should be noted that an effective rehabilitation management can successfully improve the quality of life for the child and family [7]. Accompanied with a multidisciplinary approach, affected cases with extremity hypertonicity due to cerebral impairment can get improvements in muscle tone and function [10]. In addition, many clinical trials indicate that mild hypothermia can decrease death or disability in full term infants following asphyxia and basic research and those trials also suggest that this specific approach might be combined with additional pharmacological strategies [11].…”

“…Self care as well as hygienic behavior is the primary focus for these patients. New drug such as botulinum toxin can be alternative therapeutic choice for reduction of spasticity [10]. It should be noted that an effective rehabilitation management can successfully improve the quality of life for the child and family [7].…”