Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy

Abstract

We evaluated gross motor function following botulinum toxin A (BTX‐A) injections in the lower limbs of children with spastic cerebral palsy in a randomized clinical trial, using a cross‐over design. Forty‐nine children (24 males, 25 females, age range 22 to 80 months) were randomly allocated to two groups: group 1 received BTX‐A and physiotherapy, and group 2 received physiotherapy alone for 6 months. At the end of this period, group 2 received BTX‐A and physiotherapy and group 1 continued with physiotherapy alone. Assessment measures were the Gross Motor Function Measure (GMFM), the Vulpe Assessment Battery (VAB), joint range of movement, the Modified Ashworth Scale, and a parental questionnaire. Sustained gains in gross motor function were found in both groups of children but the only additional benefit found in group 1 was a significant increase in fine motor rating on the VAB. By contrast, parents rated the benefit of treatment highly. It is likely that assessment at 3 and 6 months post injection was too late to demonstrate peak gross motor function response and that changes in GMFM are not sustained over 6 months with a single dose. Further studies should investigate changes over shorter time periods and consider covariables such as BTX‐A dosage, number of injection sites, and the role of repeated injections combined with other interventions such as casting.