Effects of botulinum toxin A on upper limb spasticity in children with cerebral palsy.
OBJECTIVE
Botulinum toxin A inhibits presynaptic release of acetylcholine at the neuromuscular junction and has reportedly been successful in the treatment of spastic disorders. This prospective study attempted to determine whether botulinum toxin A injection resulted in clinically measurable gains for 4 mo.


METHODS
Measurements were obtained from 32 children (range, 1-18 yr; average age, 6.9 yr) with hemiplegic or quadriplegic cerebral palsy before and at 1, 3, and 4 mo after botulinum toxin A injections. Spasticity was measured using the Modified Ashworth Scale for 12 different joints.


RESULTS
Results showed that spasticity as measured by Ashworth scores for elbow and wrist extension clearly declined (P < 0.02) by 1 mo after botulinum toxin A injection, and diminished spasticity continued for 3-4 mo. Caregivers reported improvement in subjectively rated management, appearance, and function. However, patient response to botulinum toxin A injection was not predictable. Age had no significant relationship to gains.


CONCLUSIONS
Further research is needed on the use of botulinum toxin A to diminish spasticity and improve function.
Friedman
A
A
Physical Medicine and Rehabilitation Center, Englewood, New Jersey, USA.
Diamond
M
M
Johnston
M V
MV
Daffner
C
C
D000293:Adolescent; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000503:physiopathology; D006429:Hemiplegia; D006801:Humans; D007223:Infant; D009128:Muscle Spasticity / Q000188:drug therapy / Q000503:physiopathology; D011446:Prospective Studies; D011782:Quadriplegia; D016059:Range of Motion, Articular; D014955:Wrist Joint / Q000503:physiopathology
D018726:Anti-Dyskinesia Agents; D019274:Botulinum Toxins, Type A