Managing spasticity in pediatric cerebral palsy using a very low dose of botulinum toxin type A: preliminary report

OBJECTIVE: To determine if very low doses of botulinum toxin type A (BTX-A) could reduce spasticity and improve gait in cerebral palsied children when combined with rehabilitation therapy. DESIGN: Ten trainable (IQ > 80), ambulatory, spastic diplegic or hemiplegic cerebral palsied children, with no fixed contractures in at least one limb, were selected for the study. Patients with a score of 3 on a modified Ashworth scale received 0.5 units of BTX-A/kg/muscle. Patients with an Ashworth score of 4 received 1.0 BTX-A/kg/muscle. After BTX-A injection, all patients received rehabilitation therapy and plastic ankle and foot orthoses for walking. RESULTS: Both groups exhibited improvement in Ashworth score and in gait within 72 hr of injection with botulinum toxin. Beneficial effects persisted for 10 to 12 mo in most patients, with three patients exhibiting benefits for at least 20 mo. CONCLUSIONS: The results of the present study indicate that a very low dose of botulinum toxin type A combined with'rehabilitation therapy resulted in a long-lasting decrease in spasticity and an improvement in gait in children with cerebral palsy.