The use of botulinum toxin type A in spastic diplegia due to cerebral palsy

Spastic diplegia is a severely disabling condition and many current treatment options offer the patient no real therapeutic benefit. Intramuscular injection of botulinum toxin type A (BTX‐A) has demonstrated the ability to decrease spasticity, improve mobility and delay the need for surgery in patients with spastic diplegia. The study described here was a pilot to a larger study and it aimed to identify the most suitable and sensitive outcome measures to detect the benefits of BTX‐A injection. Five adolescents with hip spasticity due to cerebral palsy were injected with BTX‐A into the psoas major muscle (for thigh adduction problems) or the soleus muscle (to correct ‘toe clawing’). Assessments of gait and mobility were carried out every month for the 4‐month study period. Following injection with BTX‐A, improvement in patient mobility was most evident in subjects with thigh adduction problems. A reduction in 10‐m walking time and an increase in stride length was also more pronounced in patients injected in the psoas. Three of the five patients treated demonstrated an improved Modified Ashworth Scale score at the end of the 4‐month observation period. The results conclude that spastic diplegics with problems related to the hip, may benefit from BTX‐A. Patients who experience ‘toe clawing’ present different problems and the measures used did not pick up on the benefits gained by the patients.