title: Botulinum toxin a treatment in children with cerebral palsy: its effects on walking and energy expenditure.
abstract: OBJECTIVE
  This study aimed to evaluate the effects of botulinum toxin A (BTX-A) treatment on energy expenditure and ambulation in children with cerebral palsy (CP) and to determine if energy expenditure measurement could be considered a useful tool for evaluating the effectiveness of BTX-A treatment for CP.
  
  
  METHODS
  The study included 16 pediatric CP patients with equinus deformity who were capable of walking without assistance (group with CP). The children with CP were administered BTX-A injections into the gastrocnemius muscle. All the children underwent three-dimensional gait analysis and energy expenditure measurement before injection and 8 wks after injection, the results of which were compared with those of children without CP (control group).
  
  
  RESULTS
  After BTX-A treatment, oxygen consumption in the group with CP was significantly lower than at pretreatment and was similar to that in the control group (P > 0.05). In the group with CP, post-BTX-A treatment ankle joint dorsiflexion angle at initial contact, mid-stance, and mid-swing improved significantly (P < 0.05).
  
  
  CONCLUSIONS
  BTX-A injected into the gastrocnemius muscle in children with CP not only reduced spasticity and improved ankle range of motion and walking pattern but also reduced energy consumption, resulting in functional improvement. Energy expenditure measurement can be considered an objective quantitative tool for clinical evaluation of the functional outcome of therapeutic interventions such as BTX-A.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, TAF Rehabilitation and Care Center, Bilkent, Ankara, Turkey.
authors.forename: Birol
authors.initials: B
authors.lastname: Balaban
authors.forename: Fatih
authors.initials: F
authors.lastname: Tok
authors.forename: A Kenan
authors.initials: AK
authors.lastname: Tan
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Matthews
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004734:Energy Metabolism / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012016:Reference Values; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A