Effects of botulinum toxin injections on function and quality of life in children with cerebral palsy
Prof Sameh GHROUBIa, Dr Wafa ELLEUCHa, Dr Atika MALLEKa, Dr Saoussan MAHERSIa, Prof Mohamed Habib ELLEUCHa
a Service de Médecine Physique et de Réadaptation, CHU Habib Bourguiba, Sfax, Tunisie, et Unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax
Introduction: Our objective was to show the effects of botulinum toxin injections (BT) on function and quality of life in children with cerebral palsy (CP).
Patients and methods: A prospective study including 60 children, aged from 2 to 18 years old, who received repeated injections of BT was conducted. Evaluations were done before and after injections including spasticity using the modified Ashworth scale (MAS), functional evaluation using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), a videographic record, an evaluation of satisfaction (Visual analogical scale) and an evaluation of the quality of life using the Child Health Questionnaire Parent form 50 Questionnaire (CHQ-PF50).
Results: The average of the MAS was 2.5 for all injected muscles. 65% of children were classed level I, II or III of MACS. All our patients had BT injections. The sural triceps was the most injected muscle. The improvement of spasticity after BT injections in the lower limb was more important for 6- year-old children (improvement of 46%, p<0.001). We noted a significant increase of the number of walking patients (p<0.001) and a beneficial effect on the pattern gait especially for children level III of GMFCS. The percentage of children improved (in GMFCS and MACS) and the average of visual analogical satisfaction scale as well, increased from one injection to another reaching a constant level in the last 2 injections (p <0.001). We have noted an improvement in the score of CHQ-PF50 (physical and psychosocial score) which was correlated with the functional improvement.
Discussion: Our study shows how BT injections can induce a functional gain in children with CP. An improvement of upper extremity's function, gait pattern and the quality of life upturn were plainly noticed after these injections. Similar benefits of BT [1, 2] were mentioned in literature.
1. El O et al.Botulinium toxin type A injection for spasticity in diplegic type cerebral palsy.J Child Neurol.2006;21:1009-12.
2. Wallen MA et al. Functional outcomes of intramuscular botulinum toxin type A in the upper limbs of children with cerebral palsy: a phase II trial. Arch Phys Med Rehabil.2004.85:192-200.
Keywords : cerebral palsy, botulinium toxin, Gross Motor Function Classification System, Manual Ability Classificaton System, Child Health Questionnaire parent form 50, function, qualitiy of life