Does botulinum toxin prevent or promote deformity in children with cerebral palsy?

摘要

In this issue, Tedroff et al. report the outcome of a prospective uncontrolled study on the effect of botulinum toxin A (BoNT-A) on the lower limb muscles of children with spastic cerebral palsy (CP). The study group is heter-ogenous in terms of age, Gross Motor Function Classification System (GMFCS) level, topographical pattern of CP, and level of deformity. It consists of children with CP having BoNT-A treatment for spasticity which interfered with function or the use of orthoses, or which was associated with a reduction in joint range of motion. Children awaiting orthopaedic surgery were excluded. BoNT-A was not used in isolation: most (92%) of the children used ankle-foot orthoses, and serial casting was performed in addition for 3 weeks following injection in children who did not have ankle dorsifiexion past neutral. Outcome measures were limited to the modified Ashworth scale and joint range of motion measures. Injections were repeated, to a maximum of 8 injections per muscle, when the authors and families noted a favourable outcome from previous injections. They found a persistent reduction in muscle tone in the muscles injected but a progressive reduction in joint passive ranges, following an initial improvement#