title: Multilevel botulinum toxin type a as a treatment for spasticity in children with cerebral palsy: a retrospective study.
abstract: BACKGROUND
  Cerebral palsy is the most common cause of physical disability in children. Spasticity is a disabling clinical symptom that is prevalent among patients suffering from cerebral palsy. The treatment of spasticity with botulinum toxin type A (BTX-A) is a well-established option in the interdisciplinary management of spasticity, providing focal reductions in muscle tone in cerebral palsy patients.
  
  
  OBJECTIVE
  The aim of this retrospective study was to describe the effect of multilevel BTX-A injections in the lower extremities, focusing mainly on gross motor function and functional status in cerebral palsy patients.
  
  
  METHODS
  Data from 71 cerebral palsy patients (64% male, 36% female, mean age 6.7 +/-3.2 years) were analyzed retrospectively. We used the Ashworth and Tardieu scales to evaluate the degree of spasticity. Motor function was measured by the Gross Motor Function Measure (GMFM-88), and functional status was classified by the Gross Motor Function Classification System (GMFCS I-V). Multilevel BTX-A injections were applied after sedation and with electrostimulation guidance. The evaluations were repeated every three months, and the patients were followed for six months.
  
  
  RESULTS
  We found that the Ashworth and Tardieu scores decreased significantly at the three-month evaluation (p<0.05) but not at the six-month evaluation (p>0.05). Although the improvement in spasticity was not maintained at the six-month evaluation, GMFM-88 scores increased significantly at the three- and six-month assessments. GMFSC levels showed no change in the three- and six-month assessments.
  
  
  CONCLUSIONS
  We believe that a single multilevel BTX-A injection reduces spasticity and improves motor function in children with cerebral palsy.
authors.affiliation: Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Physical Medicine and Rehabilitation - Ankara, Turkey.
authors.forename: Ece
authors.initials: E
authors.lastname: Unlu
authors.forename: Alev
authors.initials: A
authors.lastname: Cevikol
authors.forename: Burcu
authors.initials: B
authors.lastname: Bal
authors.forename: Emel
authors.initials: E
authors.lastname: Gonen
authors.forename: Ozlem
authors.initials: O
authors.lastname: Celik
authors.forename: Gulşen
authors.initials: G
authors.lastname: Kose
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009048:Motor Skills / Q000502:physiology; D009128:Muscle Spasticity / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A