Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy.
This study evaluated the effects of multilevel botulinum toxin type A (BTX-A) treatments on the gait pattern of children with spastic cerebral palsy (Gross Motor Function Classification System Levels I-III). In this nested case-control design, 30 children (mean age 6y 11mo [SD 1y 5mo]; 21 males, nine females; 19 with hemiplegia, 11 with diplegia) were treated according to best practice guidelines in paediatric orthopaedics, including BTX-A injections. A matched control group of 30 children (mean age 7y 8mo [SD 1y 10mo]; 13 males, 17 females; 19 with hemiplegia, 11 with diplegia) were treated identically, but without BTX-A. Motor development status at 5 to 10 years of age was assessed by means of three-dimensional gait analysis at a mean time of 1 year 10 months (SD 10mo) after the last BTX-A treatment. The control group showed a significantly more pronounced pathological gait pattern than the BTX-A group. Major differences were found for pelvic anterior tilt, maximum hip and knee extension, and internal hip rotation. These results provide evidence for a prolonged effect of BTX-A and suggest that BTX-A injections, in combination with common conservative treatment options, result in a gait pattern that is less defined by secondary problems (e.g. bony deformities) at 5 to 10 years of age, minimizing the need for complex surgery at a later age and enhancing quality of life.
Desloovere
Kaat
K
Clinical Motion Analysis Laboratory, Department of Rehabilitation Sciences, University Hospital Pellenberg, Catholic University of Leuven, Belgium. kaat.desloovere@uz.kuleuven.ac.be
Molenaers
Guy
G
De Cat
Jos
J
Pauwels
Petra
P
Van Campenhout
Anja
A
Ortibus
Els
E
Fabry
Guy
G
De Cock
Paul
P
D019274:Botulinum Toxins, Type A / Q000494:pharmacology* / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D005260:Female; D005684:Gait / Q000187:drug effects*; D006429:Hemiplegia / Q000188:drug therapy / Q000453:epidemiology; D006615:Hip / Q000503:physiopathology; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000187:drug effects*; D009465:Neuromuscular Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D012399:Rotation; D012720:Severity of Illness Index
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A