THE ROLE OF BOTULINUM TOXIN IN THE TREATMENT OF LOWER-LIMB SPASTICITYIN CHILDREN WITH CEREBRAL-PALSY - A PILOT-STUDY

The use of botulinum toxin in cerebral palsy is still experimental. We conducted a pilot clinical trial with botulinum toxin injections on 1 4 children with spastic cerebral palsy. All patients were mobile with dynamic contractures of the gastrocnemius-soleus muscles. The injectio ns were monophasic in 9 patients and biphasic in 5 patients. Improveme nt in dorsiflexion, quality of gait and grade of independence were ach ieved in 3 patients; improvement in dorsiflexion and quality of gait w ere achieved in 6 patients. There was no significant change in quality of gait in 4 patients. The beneficial effect lasted 4-9 months (mean 6.7 months). A combined functional score given by the physicians, ther apists and parents showed a marked improvement in 6 patients (42.9%), a mild improvement in 3 patients (21.4%) and no improvement in 5 patie nts (35.7%). Biphasic injections were slightly more effective than mon ophasic injections (p < 0.02). Adverse effects were usually mild. We c onclude that botulinum toxin may be used for the reduction of spastici ty in patients with cerebral palsy who Rave dynamic deformities of the ankle joints.