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Europa Medicophysica 2001 June;37(2):83-92

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English

Use of botulinum toxin type A in walking disorders of children with cerebral palsy

Paolicelli P. B., Ferrari A., Lodesani M., Muzzini S., Sassi S., Maoret A., Bianchini E., Cioni G.

From the Division of Child Neurology and Psychiatry University of Pisa and IRCCS Stella Maris - Pisa *Children Regional Rehabilitation Unit S. Maria Nuova Hospital - Reggio Emilia

Background. Spasticity is the ­most fre­quent alter­a­tion in mus­cle ­tone in cere­bral pal­sy (CP), but it can ­also rep­re­sent a func­tion­al com­pen­sa­tion. Moreover, appar­ent­ly sim­i­lar con­trac­tion dis­or­ders can be the ­final ­result of dif­fer­ent path­o­phy­sio­log­i­cal mech­a­nisms, requir­ing dif­fer­ent treat­ments. The aim of ­this ­study was to ver­i­fy the effec­tive­ness of botu­li­num tox­in (BTX-A) treat­ment for the man­age­ment of walk­ing dis­or­ders in a ­group of chil­dren ­with CP, select­ed fol­low­ing a func­tion­al inter­pre­ta­tion of ­their spas­tic­ity.
Methods. Gastrocnemious, sole­us, tibi­al­is pos­te­ri­or, ham­string and medi­al adduc­tor mus­cles of 54 ambu­la­to­ry CP chil­dren ­were treat­ed, sin­gu­lar­ly or in com­bi­na­tion, ­with BTX-A. The pro­to­col includ­ed: 1) clin­i­cal obser­va­tion and state­ment of expect­ed func­tion­al ­results accord­ing to GAS (Goal Attainment Scaling); 2) stan­dard­ized vid­eo-record­ing of stand­ing and walk­ing; 3) Ashworth ­scale; 4) Gross Motor Function Measure (GMFM); 5) paren­tal inter­view. All chil­dren had orthos­es and phys­i­cal ther­a­py. Controls ­were car­ried out ­before injec­tion, 4 ­months ­after, and ­then eve­ry 2 ­months.
Results. Mild and tran­si­to­ry ­side-­effects ­were ­observed in ­about a quar­ter of the chil­dren. All sub­jects ­showed a reduc­tion of spas­tic­ity and a glo­bal func­tion­al improve­ment. At GAS ­only 15% of the chil­dren did not ­achieve the expect­ed ­results of the treat­ment. A sig­nif­i­cant ­increase in stand­ing and walk­ing dimen­sions was ­observed at the ­GMFM, but ­about a quar­ter of the chil­dren did not ­show any ­change. This find­ing was prob­ably due to a “thresh­old ­effect” of the ­scale.
Conclusions. BTX-A has an effec­tive ­role in the treat­ment of chil­dren ­with CP, but its use has to be 1) pre­ced­ed by a func­tion­al inter­pre­ta­tion of the path­o­phy­sio­log­i­cal mech­a­nisms of ­child walk­ing dis­or­ders, 2) car­ried out in asso­ci­a­tion ­with oth­er treat­ments and 3) fol­lowed by stan­dard­ized eval­u­a­tions of its ­results.