title: Comparing botulinum toxin A with casting for treatment of dynamic equinus in children with cerebral palsy.
abstract: The purpose of this study was to compare the cumulative efficacy (three treatment sessions) of botulinum toxin A (BTX-A) alone, casting alone, and the combination of BTX-A and casting in the management of dynamic equinus in ambulatory children with spastic cerebral palsy (CP). Thirty-nine children with spastic CP (mean age 5y 10mo, range 3 to 9y) were enrolled in the study. A multicenter, randomized, double blind, placebo-controlled prospective study was used. Children were randomly assigned to one of three treatment groups: BTX-A only (B), placebo injection plus casting (C), or BTX-A plus casting (B+C). The dosage for the BTX-A injections was 4U/kg per extremity. Assessments were performed at baseline, 3, 6, 7.5, and 12 months with a total of three treatments administered after the evaluations at baseline, 3, and 6 months. Primary outcome measures were ankle kinematics, velocity, and stride length. Secondary outcome measures were ankle spasticity, strength, range of motion, and ankle kinetics. Group B made no significant change in any variable at any time. Groups C and B+C demonstrated significant improvements in ankle kinematics, spasticity, passive range of motion, and dorsiflexor strength. Results of this 1-year study indicate that BTX-A alone provided no improvement in the parameters measured in this study, while casting and BTX-A/casting were effective in the short- and long-term management of dynamic equinus in children with spastic CP.
authors.affiliation: Shriners Hospital for Children, Chicago, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Ackman
authors.forename: Barry S
authors.initials: BS
authors.lastname: Russman
authors.forename: Susan Sienko
authors.initials: SS
authors.lastname: Thomas
authors.forename: Cathleen E
authors.initials: CE
authors.lastname: Buckon
authors.forename: Michael D
authors.initials: MD
authors.lastname: Sussman
authors.forename: Peter
authors.initials: P
authors.lastname: Masso
authors.forename: James
authors.initials: J
authors.lastname: Sanders
authors.forename: Jacques
authors.initials: J
authors.lastname: D'Astous
authors.forename: Michael D
authors.initials: MD
authors.lastname: Aiona
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A