Botulinum toxin type A treatment of cerebral palsy: an integrated approach

We have applied a multilevel approach no the management of spasticity assoc iated with cerebral palsy (CP). All of the following factors are important in forming an integrated strategy for botulinum toxin type A (BTX-A) therap y: the timing of injections, patient selection, multilevel BTS-A treatment, optimal dosage and injection technique, follow-up treatment and objective measurements of functional outcome. Data on all these factors are presented here. CP patients had a mean age of 6.5 years (n = 315), and the dose of B TX-A (BOTOX(R)) ranged from 2 to 29 U/kg body weight (n = 156). The combina tion of muscles injected in our multilevel approach differed for patients w ith diplegia, hemiplegia and quadriplegia: patients with hemiplegia receive d injections in the gastrocnemius and medial hamstrings; this combination w as extended to the adductors for patients with diplegia and quadriplegia (n = 156). For patients with quadriplegia, muscles in a three-level (gastrocn emius, medial hamstrings, adductors and iliopsoas) or two-level (excluding the gastrocnemius) combination were also frequently injected. The duration of effect of BTX-A treatment was mainly determined by follow-up treatment c onsisting of: serial casting, day and night orthoses and physiotherapy. No major side effects of BTX-A were reported. This integrated approach appears to prolong the duration of BTX-A treatment, resulting in a duration of abo ut 1 year between injections. Eur J Neurol 6 (suppl 4):S51-S57 (C) Lippinco tt Williams & Wilkins.