Effectiveness of Multilevel Botulinum Toxin A Injection with Integrated Treatment Program on Spasticity Reduction in Non-Ambulatory Young Children with Cerebral Palsy

Abstract

Objective: The aim of the present study was to evaluate the effectiveness of multilevel Botulinum Toxin A (BTX-A) injection, as part of an integrated approach, for the treatment of spasticity in non-ambulatory young children with diplegic cerebral palsy (CP). Subjects and Methods: Seventeen non-ambulatory patients aged 4-8 years with diplegic CP (Gross Motor Function Classification System [GMFCS] level IV) were evaluated before and at 1st, 3rd, and 6th months after BTX-A injection. The effect of BTX-A on spasticity of gastrocnemius and hamstring muscles was assessed using the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). The velocity-dependent properties of spastic muscle as both slow (R2) and fast (R1) stretches were evaluated in MTS. Results: A statistically significant improvement was observed in R1 angles of gastrocnemius and hamstring muscles at 1st and 3rd months after BTX-A injection in non-ambulatory young children with CP. Statistically significant improvement was found in MAS of gastrocnemius and hamstring muscles and R2 angles of knee and ankle joint after 1st month of BTX-A injection. Conclusion: Multilevel BTX-A injection, as part of an integrated approach, can be used for focal treatment of spasticity, especially of hamstring and gastrocnemius muscles, in non-ambulatory young children with CP GMFCS level IV.