Neuropediatrics 2006; 37 - MP3
DOI: 10.1055/s-2006-943600

DETERMINANTS OF RESPONSIVENESS TO BOTULINUM TOXIN IN CHILDREN WITH CEREBRAL PALSY: PRELIMINARY RESULTS

R Yap 1, A Majnemer 2, 5, T Benaroch 1, 3, 5, MA Cantin 1, 4, 6
  • 1Shriners Hospital for Children, Montreal, QC, Canada
  • 2School of Physical and Occupational Therapy, Departments of Neurology and Neurosurgery, Pediatrics, McGill University, Montreal, QC, Canada
  • 3Department of Surgery, Division of Orthopedic Surgery, McGill University, Montreal, QC, Canada
  • 4Department of Surgery, Division of Orthopedic Surgery, University of Montreal, Montreal, QC, Canada
  • 5Montreal Children's Hospital
  • 6Ste-Justine Hospital

Objectives: To determine whether specific intrinsic and extrinsic characteristics of the child are associated with responsiveness to botulinum a toxin (BTX) and to describe the changes in muscle tone, range of motion, gait pattern, level of ambulation, functional independence and groß motor function 3 months post-injection to the gastrocnemius.

Methods: Subjects: Inclusion criteria:1)ambulatory children with spastic hemiplegia or diplegia 2)spasticity of the gastrocnemius 3)age=18 years 4)parent competent in English or French. Exclusion criteria:1)fixed ankle contracture 2)>2 large lower extremity muscles requiring treatment 3)orthopaedic surgery to the lower extremity 4)anti-spastic medication or intrathecal baclofen 5)selective dorsal rhizotomy 6)BTX injection <6 months ago. Measure: Exposures:1)age 2)number of injections 3)distribution of CP-hemiplegia, diplegia 4)parenting stress-Parenting Stress Index 5)motivation-Dimensions of Mastery Questionnaire. Outcomes:1)muscle tone-Modified Ashworth Scale 2)range of motion-passive and active 3)gait pattern-modified Physician Rating Scale 4)level of ambulation-Gillette's Functional Assessment Questionnaraire 5)functional independence-WeeFIM 6)groß motor function-GMFM 66.

Results: Thirty-one children were recruited. The mean age was 75.7±34.5 months. Younger age and fewer number of BTX treatments were associated with a greater change in groß motor function. In contrast, older children demonstrated a greater change in functional independence. Child's motivation was significantly associated with improvements in gait pattern, functional independence and level of ambulation. Parenting stress and motivation also had a modifying effect on level of ambulation. Muscle tone, range of motion, gait pattern, level of ambulation and groß motor function improved significantly 3 months post-treatment.

Conclusion: The results indicate that age, number of treatments, parenting stress and motivation influence the degree of responsiveness to BTX treatment. The findings suggest that the contribution of contextual factors (personal and environmental) on outcomes is underappreciated in children with CP.