A multilevel approach to botulinum toxin type A treatment of the (ilio)psoas in spasticity in cerebral palsy

In spasticity, flexion deformity of the hip is frequently associated with c ontracture or hyper-reflexia of the psoas muscle. Botulinum toxin type A (B TX-A) has been used for some considerable time in the management of paediat ric gait disorders. We have been using a multilevel approach to manage spas ticity in cerebral palsy for several Sears, the combination of gait analysi s and clinical evaluation being important for the selection of target muscl es for BTX-A injections. Twenty cerebral palsy children (12 female) with sp asticity were treated with BTX-A injections (BOTOX(R); mean dose, 2 U/kg bo dy weight) into the psoas muscle. Patients were monitored using range of mo tion measurements of maximal hip extension, clinical estimates of hypertoni a in the hip flexors, gait analysis (three-dimensional kinematics and kinet ics) and surface electromyography of major lower limb muscles. Full gait an alysis was carried out on 12 of the patients. Significant clinical improvem ents were observed following 15 of the 21 psoas treatments. Furthermore, th e kinematics results of gait analysis showed improvement in one or more par ameters in nine of the 12 patients. In conclusion, we have demonstrated the value of a multilevel approach to BTX-A treatment in the management of spa sticity in children with cerebral palsy. Eur J Neurol 6 (suppl 4):S59-S62 ( C) Lippincott Williams & Wilkins.