Article

AIM: To study the long-term impact of 3 years of botulinum toxin A (BoNT-A)
injections and abduction bracing on hip development in children with bilateral
spastic cerebral palsy (CP). We wanted to know if early treatment improved hip
development and reduced the need for surgery. METHOD: A long-term review of hip
morphology and surgery requirements in children who participated in a
multicentre, randomized controlled trial. The trial investigated short-term
effects of BoNT-A injections combined with an abduction brace, compared with
usual care, on hip displacement in children with bilateral spastic CP. RESULTS:
Forty-six children with bilateral spastic CP (31 males, 15 females; 10 with
diplegia, 36 with quadriplegia; mean age at enrolment of 3 y 2 mo, mean age at
most recent clinical review 13 y 11 mo [range 10 y 6 mo-16 y 8 mo]; three
children in Gross Motor Function Classification System level II, 11 in level III,
20 in level IV, 12 in level V) were followed for a mean of 10 years 10 months
from recruitment to the trial. Mean migration percentage was 15.9% in the BoNT-A
group and 15.2% in the comparison group (t = 0.26, p = 0.79). Eighty-nine percent
of hips in the treatment group and 91% hips in the comparison group had
satisfactory development, using a valid scale (Mann-Whitney U test = 867.50, z =
-1.59, p = 0.11). Forty children had preventive surgery (21 treatment group, 19
comparison group) and 18 children had reconstructive surgery (10 treatment, 8
comparison). INTERPRETATION: In children with bilateral spastic CP, early
treatment with BoNT-A and hip abduction bracing does not reduce the need for
surgery or improve hip development at skeletal maturity.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS