Botulin toxin as treatment for spasticity and dystonia in infantile cerebral paralysis

Treatment of spasticity and dystonía in PCI with Botulinum toxin A.

Background: Botulinum-A (NxTxBoA) toxin produce neuromuscular blockade, it has been effective with therapeutic purposes in strabismus, focal dystonias and spasticity.

Objective: Evaluate the therapeutically effects off NxTxBoA in cerebral palsy (CP) spastic and/or dystonic in children. Prospective study.

Methods: 12 CP patients (8 spastic and 4 spastic/dystonic) were treated with NxTxBoA in affected muscles at least for 2 doses by up 12 months. The indication was: improve limb function, to avoid surgical correction or improve hygienic or dressing. Ashworth Spasticity Scale (ASS), functional scale for Dystonic Sindou-Millet (SMS) and O'Brien Global Assessment Scale (OGAS) were used to evaluate improvement. Methods: No parametric tests, Wilcoxon's rang's test and sign test were used with p < 0.05.

Results: Total doses session was 3-10 U/kg. AAS showed muscle spasticity improvement in two grades in 8 patients, and one grade in the rest (p = 0.004). SMS showed the muscle dystonic improve up 60% in two patients improve 50% in others (p = 0.006). OGAS demonstrated a good correlation. Mean treatment effect during 4.8 months (rank 4 to 10 m). Two patients had side effects, general weakness, instability, and focal haematoma.

Conclusions: Botulinum toxin type A proved a highly useful adjuvant therapy and conservative management in CP.