title: Efficacy of botulinum toxin A, serial casting, and combined treatment for spastic equinus: a retrospective analysis.
abstract: Botulinum toxin type A (BTX-A), serial casting, and combined treatment for spastic equinus were compared by chart review. Fifty-five patients with diplegia (n=21), hemiplegia (n=17), quadriplegia (n=6), and other diagnoses (n=11) were reviewed. Thirty-one patients had Gross Motor Function Classification System (GMFCS) scores of I or II, 10 had a GMFCS score of III, and eight had GMFCS scores of IV or V (for six there were no available data). Mean age was 7 years 1 month (SD 4 y 8mo). The combined group showed a significantly greater increase in passive range of motion (ROM) of the ankle joint in comparison with BTX-A alone (p=0.0002), with a mean of 17 degrees (SD 11.2) versus 5 degrees (SD 6.7), and casting alone showed a significantly greater increase in comparison with BTX-A alone (p=0.0001), with a mean of 15 degrees (SD 4.5) versus 5 degrees (SD 6.7). With cast number controlled, change in ROM after casting with and without BTX-A was not significantly different (p=0.37). There was no significant difference between casting with or without BTX-A, and both improved ROM to a greater degree than BTX-A alone. Casting demonstrated a significantly more robust impact on range of motion than BTX-A alone.
authors.affiliation: Department of Physical Therapy, Children's Seashore House of The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. glanzmana@email.chop.edu
authors.forename: Allan M
authors.initials: AM
authors.lastname: Glanzman
authors.forename: Heakyung
authors.initials: H
authors.lastname: Kim
authors.forename: Kartik
authors.initials: K
authors.lastname: Swaminathan
authors.forename: Teresa
authors.initials: T
authors.lastname: Beck
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D003131:Combined Modality Therapy; D004576:Electromyography / Q000379:methods; D004863:Equinus Deformity / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D019957:Motor Skills Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009984:Orthopedic Fixation Devices; D010243:Paralysis / Q000150:complications*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A