Efficacy of botulinum toxin A, serial casting, and combined treatment for spastic equinus: a retrospective analysis.

Abstract	Botulinum toxin type A (BTX-A), serial casting, and combined treatment for spastic equinus were compared by chart review. Fifty-five patients with diplegia (n=21), hemiplegia (n=17), quadriplegia (n=6), and other diagnoses (n=11) were reviewed. Thirty-one patients had Gross Motor Function Classification System (GMFCS) scores of I or II, 10 had a GMFCS score of III, and eight had GMFCS scores of IV or V (for six there were no available data). Mean age was 7 years 1 month (SD 4 y 8mo). The combined group showed a significantly greater increase in passive range of motion (ROM) of the ankle joint in comparison with BTX-A alone (p=0.0002), with a mean of 17 degrees (SD 11.2) versus 5 degrees (SD 6.7), and casting alone showed a significantly greater increase in comparison with BTX-A alone (p=0.0001), with a mean of 15 degrees (SD 4.5) versus 5 degrees (SD 6.7). With cast number controlled, change in ROM after casting with and without BTX-A was not significantly different (p=0.37). There was no significant difference between casting with or without BTX-A, and both improved ROM to a greater degree than BTX-A alone. Casting demonstrated a significantly more robust impact on range of motion than BTX-A alone.
Authors	Allan M Glanzman, Heakyung Kim, Kartik Swaminathan, Teresa Beck
Journal	Developmental medicine and child neurology (Dev Med Child Neurol) Vol. 46 Issue 12 Pg. 807-11 (Dec 2004) ISSN: 0012-1622 [Print] England
PMID	15581153 (Publication Type: Journal Article)
Chemical References	Neuromuscular Agents Botulinum Toxins, Type A
Topics	Botulinum Toxins, Type A (therapeutic use) Cerebral Palsy (complications) Child Combined Modality Therapy Electromyography (methods) Equinus Deformity (complications, drug therapy) Female Humans Male Motor Skills Disorders (diagnosis, etiology, physiopathology) Muscle, Skeletal (physiopathology) Neuromuscular Agents (therapeutic use) Orthopedic Fixation Devices Paralysis (complications) Range of Motion, Articular Retrospective Studies Severity of Illness Index Surveys and Questionnaires

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