Botulinum A toxin for treatment of lower limb spasticity in cerebral palsy - Gait analysis in 49 patients

Background: Injection of botulinum type A toxin is a new treatment for spasticity. Patients and methods: We evaluated the effect of botulinum A toxin (BTX-A) in the lower limb muscles of patients having cerebral palsy. We tested 49 patients before and, on average, 4 (2-9) months after giving the toxin. The evaluation included 3-dimensional computerized gait analysis, changes in mobility level, using the Gillette Functional Assessment Questionnaire, and gastrocnemius muscle bulk, using ultrasonographic measurements. Results: The patients were divided into 3 groups, according to the site of BTX-A administration (hamstrings, gastrocnemius and multilevel). Those who were injected in the hamstrings showed a significant improvement in only the maximum knee extension angle during the gait cycle. Those with spastic equinus who were injected in the gastrocnemius muscle responded better than the other groups. The ankle angle on the initial contact, terminal stance and preswing, maximum dorsiflexion, ankle range of motion, per cent of single support and gait velocity improved significantly. Overall, the patients showed significant improvements in motor skill performance and functional health. Interpretation: Our findings indicate that botulinum type A toxin can be given as an adjuvant to conservative treatment of patients with cerebral palsy.