The use of botulinum toxin in the treatment of spastic hip joint instability in children with cerebral palsy]

Authors present the effect of intramuscular injections of botulinum toxin A (BTX-A) in the treatment of hip instability in children with spastic cerebral palsy. MATERIAL AND METHOD: The sixty-seven non walking children (110 hips) with quadriplegia and hip instability (MP > 33% or increase of MP > 20% in the second follow-up after 12 months) were evaluated. The mean age of patients in the beginning of study was 3 years and 8 months (SD = 2 years). The patients were randomly allocated to administrations of BTX-A - group A (52 hips) or to observation - group B (58 hips). The intramuscular injections of BTX-A were performed every 3 months, bilaterally to adductors, medial hamstrings and psoas muscles. The choice of muscles for BTX-A administration was determined by the results of clinical examination consisting in dynamic assessment of joint range of motion. The groups of muscles presenting the dynamic contraction (3 and more in Ashworth Scale) were injected. The a-p radiographs were used to assess the migration percentage (MP). The average length of follow-up was 21 months. RESULTS: The mean value of MP in the group A was 38% at the beginning of treatment and 28% at the end of follow-up (difference statistically significant; p < 0.00001). The mean value of MP in the group B was 36% at the primary examination and 38% at the final examination (difference statistically significant; p < 0.00001). The mean progression (-) for the group A = 10% (improvement) and for the group B +3% (deterioration) (difference statistically significant; p < 0.00001). CONCLUSIONS: Locate specific target intramuscular injections of botulinum toxin A (BTX-A) are a useful method of prevention of the neurogenic hip dislocation in children with spastic cerebral palsy.