Botulinum toxin A treatment in toddlers with cerebral palsy.
OBJECTIVE
In this study the aim was to evaluate the effect of botulinum toxin A (BoNT-A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP).


METHODS
Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT-A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait-analysis was performed at 5 years of age.


RESULTS
Plantarflexor muscle tone in the BoNT-A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change-score in knee-flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT-A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM-66 or PEDI.


CONCLUSIONS
Early treatment of BoNT-A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.
Tedroff
K
K
Neuropediatric Unit, Astrid Lindgren Children's Hospital, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden. kristina.tedroff@ki.se
Löwing
K
K
Haglund-Akerlind
Y
Y
Gutierrez-Farewik
Em
E
Forssberg
H
H
D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy*; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000187:drug effects; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009123:Muscle Hypotonia / Q000209:etiology; D009128:Muscle Spasticity / Q000188:drug therapy; D009129:Muscle Tonus / Q000187:drug effects; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A