Treatment of cerebral palsy with botulinum toxin: Evaluation with gross motor function measure

The objective of this study was to investigate the effects of botulinum tox in A (BTA) injection in reducing muscular spasticity and improving locomoto r function in children with cerebral palsy. Thirty-eight children with spas tic cerebral palsy who were undergoing regular physical therapy were enroll ed. Twenty-eight of these received BTA injection at the hip adductors and/o r gastrocnemius, while the other 10, whose parents refused the BTA treatmen t protocol, served as the comparison group. The main outcome measures were: improvements in the severity of spasticity, walking distance, gross motor function (as assessed with the Cross Motor Function Measure, GMFM), and gai t pattern (as assessed with the Physician Rating Scale, PRS), all measured 6 and 12 weeks after the start of BTA treatment. The severity of spasticity and walking distance at baseline did not differ significantly between the two groups. However, the severity of spasticity improved markedly in the BT A group, from 2.7 to 1.5 (Modified Ashworth Scale) at the hip adductor, and from 2.9 to 1.9 at the gastrocnemius at the 6-week follow-up. The walking distance improved from 46.17 m to 55.32 m at the 6-week follow-up, and to 6 6.6 m at the 12-week follow-up in the BTA group, Marked improvements in the quality of several gross motor functions were also noted in the BTA group. The improvements in spasticity, walking distance, and gross motor function were significantly greater in the BTA group than in the comparison group. The improvements in gait pattern did not differ significantly between the B TA and comparison groups. The findings of this study show BTA injection to be an effective treatment for reducing spasticity and improving gross motor function in children with spastic cerebral palsy. GMFM provides objective evidence regarding functional improvement after treatment in this patient p opulation.