Article

The aim of this study was to determine the variables that improve
spastic equinus foot caused by cerebral palsy when treated with botulinum toxin
type A. We reviewed all patients treated for spastic equinus foot using
botulinum toxin type A (Botox) in the triceps suralis during a 3 1/2-yr period
and analyzed the results after the first injection. There were 117 patients (72
diplegic and 45 hemiplegic patients) and a total of 189 triceps suralis treated.
Variables analyzed included age, total dose per session, total dose per kilogram
for each session, total dose per triceps, triceps dose per kilogram, type of
cerebral palsy, cognitive level, botulinum toxin dilution, and physiotherapy.
Assessments of efficacy were done using a Global Assessment Scale rated
independently by parents, therapists, and a neurologist ; the Modified Ashworth
Scale; and the Modified Physician Rating Koman scale. RESULTS: Improvement was
observed in all scales (P < 0.001). The change of foot position during walking
was the best parameter for measuring improvement. There was correlation between
the grade of improvement and the dose per kilogram for each triceps suralis (P <
0.001). Patient age was inversely correlated with improvement (P = 0.043).
Diplegic and hemiplegic patients improved similarly, but the hemiplegic patients
required higher doses for each muscle (P < 0.001). The most effective dose for
diplegic patients was 3-4 IU/kg for each triceps, compared with 4-6 IU/kg for
hemiplegic patients. Different dilutions of Botox (100, 50, and 40 U/ml) resulted
in similar outcomes. No better results were achieved when 2-3 sessions/wk of
physiotherapy was added to a daily program of exercises at home to enhance foot
dorsiflexion. CONCLUSIONS: The dose per kilogram of Botox injected into triceps
suralis and the patient age influence the results.
The most effective dose is
different between diplegic and hemiplegic patients.
The concentration of
botulinum toxin type A does not play a significant role in the outcome.

Langue : ANGLAIS