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Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy

Botulinum toxin (BoNT-A) is widely used in combined treatment for
spastic cerebral palsy, but its added value preceding comprehensive
rehabilitation for motor impairments, gait, and goal attainment has not been
studied. DESIGN: A comparative multi-centre trial, in which two groups underwent
comprehensive rehabilitation (i.e. high-intensive functional physiotherapy, and
indicated casting/orthoses).
One group received intramuscular BoNT-A prior to
rehabilitation, and the other group did not receive BoNT-A. SUBJECTS/PATIENTS:
Children with spastic cerebral palsy, Gross Motor Function Classification System
(GMFCS) levels I-III, age range 4-12 years, indicated for BoNT-A treatment
regarding mobility problems. METHODS: Sixty-five children participated (37 boys),
mean age 7.3 years (standard deviation (SD) 2.3, range 4-12 years), equally
distributed across GMFCS levels. Forty-one children received BoNT-A+
comprehensive rehabilitation and 24 received comprehensive rehabilitation only.
Functional leg muscle strength, passive range of motion, angle of catch, cerebral
palsy-related pain, walking speed, kinematic gait parameters, goal attainment,
and proxy-reported general functioning were assessed at baseline, primary
end-point (12 weeks) and 24-week follow-up. Statistical analyses were performed
with linear mixed models. RESULTS: At the primary end-point there were no
statistically significant differences in treatment effects between the groups,
except for the angle-of-catch of the rectus femoris, which was in favour of
comprehensive rehabilitation without BoNT-A (12 degrees difference, 95%
confidence interval (95% CI) 2:23, p = 0.025). Results at follow-up were similar.
CONCLUSION: At the group level, treating with BoNT-A prior to comprehensive
rehabilitation did not add to the clinical effectiveness of rehabilitation. Thus,
BoNT-A prescription and use should be critically reconsidered in this cerebral palsy age- and GMFCS-subgroup.

Langue : ANGLAIS

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