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Spread of botulinum neurotoxin type a at standard doses is inherent to the successful treatment of spastic equinus foot in cerebral palsy: short-term neurophysiological and clinical study.

Abstract
To evaluate whether botulinum toxin type A at standard doses spreads to antagonist leg muscles in dynamic equinus foot, we studied 18 ambulatory children with hemiplegic cerebral palsy. The gastrocnemius muscle on the affected side was injected with botulinum toxin type A (Dysport) (mean ± standard deviation, 14.3 ± 0.9 U/kg). Compound muscle action potential areas were assessed in the lateral gastrocnemius and tibialis anterior muscles on the treated and untreated sides before botulinum toxin type A injections and on days 10 and 30 after injections. In all patients, compound muscle action potential areas recorded from both the muscles on the treated side decreased from preinjection values at day 10 (P < .05) and 30 (P < .002). After injection, ankle spasticity had diminished (P < .05), equinus foot excursion increased (P < .05), and functional gait improved (P < .05). This study shows that botulinum toxin type A spreads from foot flexors to antagonist extensors and suggests that spread may be partly responsible for improving gait in children with cerebral palsy.
AuthorsEmma Frasson, Elisa Dall'ora, Monia Bordignon, Francesco Brigo, Pierluigi Tocco, Daniela Primon, Giuseppe Didonè, Silvana Vicentini, Antonio Fiaschi, Laura Bertolasi
JournalJournal of child neurology (J Child Neurol) Vol. 27 Issue 5 Pg. 587-93 (May 2012) ISSN: 1708-8283 [Electronic] United States
PMID22114218 (Publication Type: Journal Article, Randomized Controlled Trial)
Chemical References
  • Neuromuscular Agents
  • Botulinum Toxins, Type A
Topics
  • Action Potentials (drug effects)
  • Botulinum Toxins, Type A (therapeutic use)
  • Cerebral Palsy (complications, drug therapy)
  • Child
  • Child, Preschool
  • Electromyography
  • Equinus Deformity (drug therapy, etiology)
  • Female
  • Humans
  • Leg (innervation)
  • Male
  • Muscle, Skeletal (drug effects, physiopathology)
  • Neuromuscular Agents (therapeutic use)
  • Prospective Studies
  • Time Factors
  • Treatment Outcome

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