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Botulinum Toxin A Injection for Spasticity in Diplegic-Type Cerebral Palsy

Department of Physical Medicine and Rehabilitation, Dokuz Eylul University Faculty of Medicine, Balcova 35340 Izmir, Turkey. Tel: +90 232 4123958 4123951; fax: + 90 232 2792462; elozlem{at}yahoo.com

Ozlen Peker, MD

Departments of Physical Medicine and Rehabilitation, Dokuz Eylul University, Izmir, Turkey

Can Kosay, MD

Department of Orthopaedics, Dokuz Eylul University, Izmir, Turkey

Leyla Iyilikci, MD

Departments of Anesthesia and Reanimation, Dokuz Eylul University, Izmir, Turkey

Ozgur Bozan, PT

Faculty of Medicine, and the School of Physical Therapy, Dokuz Eylul University, Izmir, Turkey

Haluk Berk, MD

Department of Orthopaedics, Dokuz Eylul University, Izmir, Turkey

Botulinum toxin type A can be both safe and effective in relieving spasticity in pediatric patients with cerebral palsy. In our prospective study, we evaluated the functional effect of botulinum toxin A in spastic diplegic-type cerebral palsy. Patients were examined on enrollment and at 1, 3, and 6 months after injection. Passive dorsiflexion of the ankle joint was measured using a goniometer as an angle of possible maximal dorsiflexion with the knee extended and flexed. Spasticity was graded using the Modified Ashworth Scale. Selective motor control at the ankle was assessed, and observational gait analysis was done. The functional status of the patients was determined by using the gross motor classification system. Botulinum toxin A was injected into the gastrocnemius muscle in all patients, and in four patients with concomitant jump knee gait, a hamstring muscle injection was added. Fourteen patients were included in the study. The mean age was 58.81 6 15.34 months. Following injection, spasticity was clinically decreased and statistically significant improvement was noticed in all clinical parameters after 1, 3, and 6 months of injection. The improvement in the clinical parameters decreased after 6 months but not to the baseline. One patient was Level II, four patients were Level III, and six patients were Level IV according to the Gross Motor Function Classification System at baseline. Improvement in the gross motor classification system is continued after 6 months in 12 children. The main goal of spasticity treatment in cerebral palsy is functional improvement. In our study, most of our patients had functional improvement according to the gross motor function classification system and did not change at 6 months.

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