The effect of botulinum toxin type A injections on the natural history of equinus foot deformity in paediatric cerebral palsy patients

Neuromuscular blockade with botulinum toxin type A (BTX-A) injections was e mployed to manage equinus foot deformity in the lower extremities of paedia tric cerebral palsy patients. The patients were followed to evaluate the ef fect of the blockade on lower extremity function and to determine the effec t of treatment on the need for tendo-Achilles lengthening (TAL) surgery. Th e average length of follow-up was 3.4 years. Of the 48 patients, 17 (35%) r esponded to treatment within 6 months of initiation of therapy, as determin ed by a physician Rating Scale of gait. Overall, 25 (52%) of the 48 patient s underwent TAL surgery during the follow-up period, including eight patien ts who responded to the BTX-A treatment. The average age of the patients at the time of surgery was 7 years. This age compares favourably with the age at surgery reported in the recent literature. There were no significant di fferences by responder status, age, or gender in those patients who did and did not require TAL surgery. No adverse events relating to BTX-A were repo rted. These results indicate that patients who respond to BTX-A treatment h ave improved physical functioning and gait, and are able to sustain these r esults long term. Eur J Neurol 6 (suppl 4):S19-S22 (C) Lippincott Williams & Wilkins.