Botulinum toxin treatment of spastic equinus in cerebral palsy: a randomized trial comparing two injection sites.
OBJECTIVE
To explore the clinical relevance of injection site by comparing two different injection techniques in children with cerebral palsy who have spastic equinus gait.


METHODS
A total of 19 children (13 boys, 6 girls; range, 1 yr 6 mos to 7 yrs; nine hemiplegics, eight diplegics, two quadriplegics; levels I to IV with the Gross Motor Function Classification System) participated in the study. The children were randomized into two groups: the proximal group received a botulinum toxin A injection into the proximal part of both heads of the gastrocnemius, and the distal group received a botulinum toxin A injection into the mid-belly of the muscle bulks. A single-point injection of BOTOX, 3 units/kg per site, was used. Assessments of active and passive range of motion, dynamic muscle length (modified Tardieu scale), calf tone (modified Ashworth scale), and video gait analysis (Observational Gait Scale) were performed before treatment and 3, 8, and 16 wks posttreatment.


RESULTS
Active and passive dorsiflexion and calf tone in both groups and Observational Gait Scale total scores in the distal group improved at all time points. The median change from baseline values in Observational Gait Scale initial foot contact and total scores at 8 wks showed a significant difference favoring the distal group, but the clinical relevance remained tenuous.


CONCLUSIONS
Using the methods described, no major changes in main outcome measures were associated with changing the injection site.
Sätilä
Heli
H
Department of Paediatric Neurology, Tampere University Hospital, Tampere, Finland.
Iisalo
Terhi
T
Pietikäinen
Tarja
T
Seppänen
Ritva-Liisa
RL
Salo
Marja
M
Koivikko
Matti
M
Autti-Rämö
Ilona
I
Haataja
Riina
R
D000843:Ankle Joint / Q000502:physiology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000502:physiology; D006429:Hemiplegia / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular / Q000379:methods; D007866:Leg; D008297:Male; D009129:Muscle Tonus / Q000187:drug effects; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D010290:Parents; D011782:Quadriplegia / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A