title: Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review.
abstract: OBJECTIVE
  To assess treatment effects of botulinum toxin type A (BoNT-A) on walking of children with leg spasticity due to cerebral palsy (CP) compared with usual care.
  
  
  METHODS
  We systematically searched the databases CINAHL, Cochrane, PEDro, EMBASE, and PubMed from July 1993 until July 2009 and additionally screened reference lists. Randomized controlled trials assessing functional outcomes on walking of children with CP were included. The intervention had to contain BoNT-A into the lower limb and be compared with usual care. The methodological quality and clinical relevance were independently assessed by two of the authors (UCR, CHGB). If statistical pooling was not feasible, we performed a best-evidence synthesis.
  
  
  RESULTS
  Eight trials were included. Trials comparing BoNT-A plus usual care or physiotherapy versus usual care or physiotherapy alone showed moderate evidence for functional outcomes at 2 to 6, 12, and 24 weeks follow-up in favour of BoNT-A. Studies comparing BoNT-A versus casting showed strong evidence for no difference in effects between these interventions. A limitation of our review was the exclusion of studies not published in English, Dutch, or German. The heterogeneity of the included studies, especially for outcome measures and follow-up assessments, prompted us to refrain from statistical pooling, which might also be considered a limitation.
  
  
  CONCLUSIONS
  The use of BoNT-A with usual care or physiotherapy seems to improve walking of children with CP, but results should be appraised carefully owing to the limited quality of included trials.
authors.affiliation: Department of Epidemiology, Caphri Research Institute, Maastricht University, Maastricht, The Netherlands.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Ryll
authors.forename: Caroline
authors.initials: C
authors.lastname: Bastiaenen
authors.forename: Rob
authors.initials: R
authors.lastname: De Bie
authors.forename: Bart
authors.initials: B
authors.lastname: Staal
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000494:pharmacology*; D002370:Casts, Surgical; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007866:Leg / Q000503:physiopathology; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D009788:Occupational Therapy; D009989:Orthotic Devices; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D016138:Walking
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A