title: Botulinum toxin type A for the treatment of equinus deformity in patients with mucopolysaccharidosis type II.
abstract: Mucopolysaccharidoses are lysosomal storage disorders that are caused by a deficiency in the enzymes that degrade glycosaminoglycans. The accumulation of glycosaminoglycans affects multiple systems, resulting in coarse facial features, short stature, organomegaly, and variable neurological changes from normal intelligence to severe mental retardation and spasticity. Effects on the musculoskeletal system include dysostosis multiplex, joint stiffness, and muscle shortening. This article reports 2 patients with mucopolysaccharidosis type II (Hunter syndrome) who showed progressive equinus deformity of the feet. Both patients were treated with intramuscular botulinum toxin type A injections in the gastrocnemius and the soleus muscles, followed by serial casting. In both patients, passive range of motion, muscle tone, and gait performance were significantly improved. Botulinum toxin type A injections followed by serial casting are a therapeutic option for contractures in patients with mucopolysaccharidosis. However, the long-term effects and the effect of application in other muscles remain unknown.
authors.affiliation: Department of Pediatric Neurology, University Children's Hospital, Berne, Switzerland.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Nava
authors.forename: Peter
authors.initials: P
authors.lastname: Weber
authors.forename: Matthias
authors.initials: M
authors.lastname: Gautschi
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Nuoffer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Grunt
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002675:Child, Preschool; D004863:Equinus Deformity / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D016532:Mucopolysaccharidosis II / Q000150:complications*; D009465:Neuromuscular Agents / Q000627:therapeutic use*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A