Faculty Collaboration Database

Comparing botulinum toxin A with casting for treatment of dynamic equinus in children with cerebral palsy. Dev Med Child Neurol 2005 Sep;47(9):620-7

Date

09/06/2005

Pubmed ID

16138670

DOI

10.1017/S0012162205001222

Scopus ID

2-s2.0-23944500518 (requires institutional sign-in at Scopus site)   109 Citations

Abstract

The purpose of this study was to compare the cumulative efficacy (three treatment sessions) of botulinum toxin A (BTX-A) alone, casting alone, and the combination of BTX-A and casting in the management of dynamic equinus in ambulatory children with spastic cerebral palsy (CP). Thirty-nine children with spastic CP (mean age 5y 10mo, range 3 to 9y) were enrolled in the study. A multicenter, randomized, double blind, placebo-controlled prospective study was used. Children were randomly assigned to one of three treatment groups: BTX-A only (B), placebo injection plus casting (C), or BTX-A plus casting (B+C). The dosage for the BTX-A injections was 4U/kg per extremity. Assessments were performed at baseline, 3, 6, 7.5, and 12 months with a total of three treatments administered after the evaluations at baseline, 3, and 6 months. Primary outcome measures were ankle kinematics, velocity, and stride length. Secondary outcome measures were ankle spasticity, strength, range of motion, and ankle kinetics. Group B made no significant change in any variable at any time. Groups C and B+C demonstrated significant improvements in ankle kinematics, spasticity, passive range of motion, and dorsiflexor strength. Results of this 1-year study indicate that BTX-A alone provided no improvement in the parameters measured in this study, while casting and BTX-A/casting were effective in the short- and long-term management of dynamic equinus in children with spastic CP.

Author List

Ackman JD, Russman BS, Thomas SS, Buckon CE, Sussman MD, Masso P, Sanders J, D'Astous J, Aiona MD, Shriners Hospitals BTX-A Study Group

Author

Gerald Harris PhD Director in the Orthopaedic Research Engineering Center (OREC) department at Marquette University

MESH terms used to index this publication - Major topics in bold

Ankle Joint
Biomechanical Phenomena
Botulinum Toxins, Type A
Casts, Surgical
Cerebral Palsy
Child
Child, Preschool
Clubfoot
Combined Modality Therapy
Double-Blind Method
Female
Follow-Up Studies
Gait
Humans
Injections, Intramuscular
Male
Prospective Studies
Treatment Outcome