BOTULINUM TOXIN IN THE MANAGEMENT OF THE LOWER-LIMB IN CEREBRAL-PALSY

The role of intramuscular botulinum toxin A in the treatment of 26 chi ldren with cerebral palsy was evaluated. The indication for injection was the presence of a dynamic contracture of lower-limb muscles interf ering with positioning or walking. Spastic target muscles were identif ied by clinical examination and, in ambulant children, by gait analysi s. Between 50 and 320 units of botulinum toxin were injected into each muscle group to a total dose of 100 to 400 units per child. The effec ts of injection were monitored by repeated clinical examination and ga it analysis. There were no clinically detectable systemic side-effects , and all but one patient had a reduction in tone, which occurred with in three days and persisted for two to four months. There were signifi cant improvements in ambulatory status and in sagittal-plane kinematic s. in some cases these gains persisted after the tone-reducing effects of the toxin had worn off.