Efficacy of Multilevel Botulinum Toxin Type A Injections Applied to the Lower Limb in a Single Session for Children with Spastic Cerebral Palsy

Objective: Dynamic spasticity may develop into static contractures in children with cerebral palsy. The study aimed to evaluate the efficacy of multilevel botulinum toxin type A (BtA) in children with spastic cerebral palsy, when combined with casting, followed by physical therapy and orthotics. Methods: We retrospectively evaluated changes in physical examination and walking in 12 children treated at our institution between January and December 2014 using three-dimensional gait analysis at baseline, and 3 months and 6 months after treatment. We administered BtA 6-8 IU/ kg to four points in gastrocnemius and 4-6 IU/kg BtA to two points in the hamstrings. A long-leg cast was applied for 10 days after the injections, after which an ankle-foot orthosis was supplied to all carers and an intensive physical therapy program was undertaken. Results: Three months after injection, we observed significant improvements in cadence, stride time and velocity, and knee flexion at initial contact and maximum knee extension during the stance phase, but these had returned to baseline by 6 months. However, significant improvements from baseline in ankle plantar flexion at initial contact, maximum ankle dorsiflexion during the stance phase and maximum ankle plantar flexion during the terminal stance phase persisted for 6 months. Conclusion: A single session of multilevel BtA treatment combined with casting, intensive physical therapy and orthosis use appears to be an effective means of preventing static contractures in children with cerebral palsy for up to 6 months.