RT Journal Article
SR Electronic
T1 Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 481
OP 487
DO 10.1136/adc.83.6.481
VO 83
IS 6
A1 T Ubhi
A1 B B Bhakta
A1 H L Ives
A1 V Allgar
A1 S H Roussounis
YR 2000
UL http://adc.bmj.com/content/83/6/481.abstract
AB BACKGROUND Cerebral palsy is the commonest cause of severe physical disability in childhood. For many years treatment has centred on the use of physiotherapy and orthotics to overcome the problems of leg spasticity, which interferes with walking and can lead to limb deformity. Intramuscular botulinum toxin (BT-A) offers a targeted form of therapy to reduce spasticity in specific muscle groups.AIMS To determine whether intramuscular BT-A can improve walking in children with cerebral palsy.DESIGN Randomised, double blind, placebo controlled trial.METHODS Forty patients with spastic diplegia or hemiplegia were enrolled. Twenty two received botulinum toxin and 18 received placebo. The primary outcome measure was video gait analysis and secondary outcome measures were gross motor function measure (GMFM), physiological cost index (PCI), and passive ankle dorsiflexion.RESULTS Video gait analysis showed clinically and statistically significant improvement in initial foot contact following BT-A at six weeks and 12 weeks compared to placebo. Forty eight per cent of BT-A treated children showed clinical improvement in VGA compared to 17% of placebo treated children. The GMFM (walking dimension) showed a statistically significant improvement in favour of the botulinum toxin treated group. Changes in PCI and passive ankle dorsiflexion were not statistically significant.CONCLUSION The study gives further support to the use of intramuscular botulinum toxin type A as an adjunct to conventional physiotherapy and orthoses to reduce spasticity and improve functional mobility in children with spastic diplegic or hemiplegic cerebral palsy.