Premium
Long‐term effects of botulinum toxin A in children with cerebral palsy
Author(s) -
TEDROFF KRISTINA,
GRANATH FREDRIK,
FORSSBERG HANS,
HAGLUNDAKERLIND YVONNE
Publication year - 2009
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/j.1469-8749.2008.03189.x
Subject(s) - muscle tone , cerebral palsy , medicine , botulinum toxin , spasticity , muscle contracture , spastic , gross motor function classification system , range of motion , spastic cerebral palsy , contracture , anesthesia , physical medicine and rehabilitation , physical therapy , surgery
The long‐term effects of botulinum toxin A (BoNT‐A) treatment in children with cerebral palsy (CP) are still elusive. We studied a prospective clinical cohort of 94 children with different subtypes (50% spastic diplegic CP, 22% hemiplegic CP, 25% tetraplegic CP, 3% dyskinetic CP), sex (55% male, 45% female), severity according to Gross Motor Function Classification System (29% Level I, 15% Level II, 16% Level III, 17% Level IV, 23% Level V), and age (median 5y 4mo, range 11mo–17y 8mo). The longest follow‐up time was 3 years 7 months (median 1y 6mo) and included a maximum of eight injections per muscle (median two injections to a specific muscle). Outcome measurements were muscle tone (Modified Ashworth Scale) and joint range of motion (ROM). Assessments were made at a minimum before and 3 months after each injection. Ninety‐five per cent confidence intervals for differences from baseline were used to identify significant changes. BoNT‐A injections induced reduction of long‐term spasticity in all muscle‐groups examined: the gastrocnemius, hamstring, and adductor muscles. The reduction in tone was most distinct in the gastrocnemius muscle, and each repeated injection produced an immediate reduction in muscle tone. However, improvement in ROM was brief and measured only after the first injections, whereupon the ROM declined. Thus, the results suggest that BoNT‐A can be effective in reducing muscle tone over a longer period, but not in preventing development of contractures in spastic muscles. The dissociation between the effects on muscle tone and ROM indicates that development of contractures is not coupled to increased muscle tone only, but might be caused by other mechanisms.