Effect of multilevel lower-limb botulinum injections & intensive physical therapy on children with cerebral palsy.

Abstract

BACKGROUND & OBJECTIVES:

Botulinum toxin is considered as an effective treatment for spasticity in children with cerebral palsy (CP). However, there are only a few long-term studies, and the effects on motor function have been inconclusive. Moreover, due to its high cost and need for intensive post-injection therapy, utility in context of developing nations has not been established. This retrospective study was undertaken to assess the long term effects of botulinum toxin-A with physical therapy in children with CP.

METHODS:

This retrospective study was conducted at a tertiary care centre in India, where a limited supply of botulinum toxin was introduced in the year 2009. It was used in a selective group of patients with CP along with intensive physical therapies. All children who received lower-limb botulinum injections over a 42-month period were analyzed. For evaluation of treatment effect, the measurement at 1st pre-injection assessment and the last measurements, i.e. 12 wk after last injection received by that child were compared.

RESULTS:

Twenty nine patients (20 males, median age 51 months) received 69 sessions of botulinum toxin injections in the lower limbs over a 42-month period. Thirteen patients were diplegic, 10 were quadriplegic, five were triplegic and one was hemiplegic. There was a significant improvement in pre- and post-injection scores on Observational Gait Scale (right side 7.1±3.6 to 10.7±3.7, left side 6.7±3.5 to 9.9±3.4), Gross Motor Function Measure Scale (47.9±17.7 to 67.6±17.2), Modified Ashworth Scale, passive range of motion and Gross Motor Function Classification System. Most of the patients showed gain in motor milestones as well.

INTERPRETATION & CONCLUSIONS:

Our results showed that judicious use of botulinum injections along with intensive physio/occupational therapies could yield good results in children with CP.

• Authors: Monica Juneja, Rahul Jain, Ankita Gautam, Ritu Khanna, Kamia Narang
• Journal: The Indian journal of medical research (Indian J Med Res) Vol. 146 Issue Supplement Pg. S8-S14 (Nov 2017) ISSN: 0971-5916 [Print] India
• PMID: 29578189 (Publication Type: Journal Article)

Chemical References

• Botulinum Toxins, Type A

Topics

• Botulinum Toxins, Type A (administration & dosage)
• Cerebral Palsy (therapy)
• Child, Preschool
• Combined Modality Therapy
• Female
• Humans
• Injections
• Lower Extremity
• Male
• Physical Therapy Modalities
• Retrospective Studies