BOTULINUM TOXIN-A IN THE HEMIPLEGIC UPPER-LIMB - A DOUBLE-BLIND TRIAL

In a randomised, double-blind study, the effects of intramuscular inje ction of botulinum toxin type A (BtA) into the upper limb were compare d with those of normal saline solution in 14 patients with cerebral pa lsy; their mean age was 9 years. Range of movement and function were a ssessed before injection and at 2 and 12 weeks after injection. BtA in jection significantly increased maximum active elbow and thumb extensi on and significantly reduced tone at wrist and elbow. The hand grasp-a nd-release score improved, representing a modest functional change, bu t fine motor function, assessed by the ability to pick up coins, did n ot improve and in some cases deteriorated temporarily. The most notabl e subjective change was the cosmetic benefit of reduced involuntary el bow flexion. The tone-reducing effect of BtA was clinically detectable in comparison with the placebo and patients and parents perceived the change as beneficial. The median of changes in the treatment group wa s small but the range was large, suggesting that BtA can be useful in selected patients.