title: A pilot study of delayed versus immediate serial casting after botulinum toxin injection for partially reducible spastic equinus.
abstract: BACKGROUND
  Serial casting is often prescribed after botulinum toxin injections to improve joint ranges of motion and to potentiate the decrease in hypertonia. The aim of this study was to compare delayed versus immediate serial casting as an adjunct to botulinum toxin therapy for partially reducible spastic equinus.
  
  
  METHODS
  Twelve children who presented spastic equinus associated with mild gastrosoleus contracture took part. Five of them had a diagnosis of spastic diplegia, whereas 7 had a diagnosis of congenital hemiplegia. Children were randomized to immediate serial casting (same day) or delayed serial casting (4 weeks later) after botulinum toxin injection to their gastrosolei. Casts were replaced weekly for 3 weeks.
  
  
  RESULTS
  Three children complained of pain that required recasting in the immediate casting group versus none in the delayed casting group (P = 0.08). At 3 months, there was a 27-degree improvement in the fast dorsiflexion angle (Tardieu R1) in the delayed casting group versus 17 degrees in the immediate casting group (P = 0.029). At 6 months, a 19-degree improvement persisted in the delayed group compared with 11 degrees in the immediate group (P = 0.010).
  
  
  CONCLUSIONS
  There is a clear benefit in delaying serial casting after the injection of botulinum toxin in the recurrence of spasticity at the gastrosoleus that may also offer an advantage regarding the incidence of painful episodes associated with casting. Most importantly, reducing the recurrence of spasticity by delayed serial casting may offer the possibility of decreasing the frequency of botulinum toxin reinjections.
authors.affiliation: Paediatric Neurorehabilitation Unit, Lausanne University Hospital, Switzerland. Christopher.Newman@chuv.ch
authors.forename: Christopher John
authors.initials: CJ
authors.lastname: Newman
authors.forename: Ann
authors.initials: A
authors.lastname: Kennedy
authors.forename: Michael
authors.initials: M
authors.lastname: Walsh
authors.forename: Timothy
authors.initials: T
authors.lastname: O'Brien
authors.forename: Bryan
authors.initials: B
authors.lastname: Lynch
authors.forename: Owen
authors.initials: O
authors.lastname: Hensey
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004863:Equinus Deformity / Q000188:drug therapy* / Q000209:etiology; D006429:Hemiplegia / Q000188:drug therapy*; D006801:Humans; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D010865:Pilot Projects; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A