Botulinum Toxin in the Management of Children with Cerebral Palsy
AbstractDuring the past 25 years, botulinum toxin type A (BoNT-A) has become the
most widely used medical intervention in children with cerebral palsy. In this
review we consider the gaps in our knowledge in the use of BoNT-A and reasons why
muscle morphology and function in children with cerebral palsy are impaired. We
review limitations in our knowledge regarding the mechanisms underlying the
development of contractures and the difficulty in preventing them. It is clear from
this review that injection of BoNT-A in the large muscles of both the upper and
lower limbs of children with cerebral palsy will result in a predictable decrease in
muscle activity, which is usually reported as a reduction in spasticity, for between 3 and 6 months. These changes are noted by the use of clinical tools such as the
Modified Ashworth Scale and the Modified Tardieu Scale. Decreased muscle
over-activity usually results in improved range of motion in distal joints. Injection of the gastrocnemius muscle for toe-walking in a child with hemiplegia or
diplegia usually has the effect of increasing the passive range of dorsiflexion at
the ankle. In our review, we found that this may result in a measurable improvement in gait by the use of observational gait scales or gait analysis, in some children.
However, improvements in gait function are no...
Source: Pediatric Drugs - Category: Pediatrics Source Type: research
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