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Botulinum Toxin Type A Injections for Treatment of Spastic Equinus in Cerebral Palsy

A Secondary Analysis of Factors Predictive of Favorable Response

Sätilä, Heli, MD, PhD; Huhtala, Heini, MSc

American Journal of Physical Medicine & Rehabilitation: November 2010 - Volume 89 - Issue 11 - p 865-872
doi: 10.1097/PHM.0b013e3181f1c5e7
Original Research Article: Spasticity

Sätilä H, Huhtala H: Botulinum toxin type A injections for treatment of spastic equinus in cerebral palsy: A secondary analysis of factors predictive of favorable response.

Objective: To investigate markers predicting favorable botulinum toxin injection outcomes in treating spastic equinus gait in children with cerebral palsy.

Design: Thirty-six children (21 boys and 15 girls, aged 1.5–9.6 yrs; 20 with unilateral and 16 with bilateral cerebral palsy levels I to IV with the Gross Motor Function Classification System) with 49 treated lower limbs were included. Passive range of movement, selective dorsiflexion, dynamic muscle length (modified Tardieu Scale), calf tone (modified Ashworth Scale), attainment of anticipated gait pattern (Goal Attainment Scale), and video gait analysis (Observational Gait Scale) were assessed before and 1, 2, and 4 mos after intervention. Participants were classified as poor or good responders, according to the Goal Attainment Scale response at 2 mos.

Results: Good response was noted in 23 (64%) children and 29 (59%) legs, whereas 13 (36%) children and 20 (41%) legs were defined as poor responders. In a multivariate regression analysis, the best predictors of good response per child were higher initial Observational Gait Scale total scores, one-level treatment, and normal cognition; and the best predictors per leg were good initial selective motor control in the ankle and capability of occasional flatfoot contact at pretreatment.

Conclusions: These results suggest that children with less severe functional deficit, fair to good selective motor control in the ankle, and mild equinus gait respond best to focal botulinum toxin type A treatment, with an eye to flatfoot or heel strike contact. Likewise, children with higher cognitive level seem to derive functional benefit from the treatment.

From the Department of Paediatric Neurology (HS), Tampere University Hospital, Tampere; Department of Paediatric Neurology (HS), Kanta-Häme Central Hospital, Hämeenlinna; and School of Public Health (HH), University of Tampere, Tampere, Finland.

All correspondence and requests for reprints should be addressed to Heli Sätilä, MD, Paediatric Neurology Unit, Kanta-Häme Central Hospital, SF-13530 Hämeenlinna, Finland.

Supported in part by the Medical Research Fund of Kanta-Häme Central Hospital, Finland. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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