title: Treatment of spastic equinus gait with botulinum toxin A: Does dose matter? Analysis of a clinical cohort.
abstract: BACKGROUND
  This study reports the effects of various doses of BTX-A when treating equinus gait in cerebral palsy in a clinical setting at a tertiary hospital.
  
  
  METHODS
  Twenty-nine children with CP (age 1.5-9.6 yrs, GMFCS I-IV) met the preset inclusion criteria. The treatment episodes per child ranged from 1 to 5 and the effects on a total of 80 legs in 55 treatment sessions were evaluated.
  
  
  METHODS
  BTX-A doses injected into the gastroc-soleus muscle were divided into low- (<or= 6 units/kg bw) and high- (> 6 units/kg bw) dose groups. The outcome measurements included active and passive ankle range of movement, Modified Ashworth Scale, dynamic muscle length, Selective Motor Control score, Observational Gait Scale score, and Goal Attainment Scale score at pre-treatment and 1, 2, and 4 months post-treatment.
  
  
  RESULTS
  The only differences between the treatment groups were observed at 2 and 4 months in terms of change in passive ankle ROM and at 4 months in change in selective dorsiflexion, favouring the low-dose group. The incidence and severity of side-effects did not differ between the groups.
  
  
  CONCLUSIONS
  Doses over 6 units/kg bw injected into the gastroc-soleus muscle do not necessarily yield superior results compared with lower doses.
authors.affiliation: Department of Pediatric Neurology, Central Hospital of Kanta-Häme, Hämeenlinna, Finland. heli.satila@khshp.fi
authors.forename: H K
authors.initials: HK
authors.lastname: Sätilä
authors.forename: T
authors.initials: T
authors.lastname: Pietikäinen
authors.forename: P
authors.initials: P
authors.lastname: Lehtonen-Räty
authors.forename: M
authors.initials: M
authors.lastname: Koivikko
authors.forename: I
authors.initials: I
authors.lastname: Autti-Rämö
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004863:Equinus Deformity / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009460:Neurologic Examination / Q000187:drug effects; D016059:Range of Motion, Articular / Q000187:drug effects; D012189:Retrospective Studies
chemical_list: D019274:Botulinum Toxins, Type A