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N.B. We at UDAAN rarely now go in for Botox or Phenol Nerve Block in relieving spasticity in CP. The effect of these injections are magical: the child starts walking near normally within 5 minutes to a day. The doctor is happy, the parents are happy, the child is happy. In all this happiness, intensive Standard Therapy is given the go-by. Result: back to the pavilion within a year and Rs.15000 + (US $ 350 or more) gone down the drain. Last revised January 21, 2007.

• AUTHOR - Yang TF et al
  TITLE - Treatment of cerebral palsy with botulinum toxin: evaluation with gross motor function measure.
  ABSTRACT - The objective of this study was to investigate the effects of botulinum toxin A (BTA) injection in reducing muscular spasticity and improving locomotor function in children with cerebral palsy. Thirty-eight children with spastic cerebral palsy who were undergoing regular physical therapy were enrolled. Twenty-eight of these received BTA injection at the hip adductors and/or gastrocnemius, while the other 10, whose parents refused the BTA treatment protocol, served as the comparison group. The main outcome measures were:improvements in the severity of spasticity, walking distance,gross motor function (as assessed with the Gross Motor Function Measure, GMFM), and gait pattern (as assessed with the Physician Rating Scale, PRS), all measured 6 and 12 weeks after the start of BTA treatment. The severity of spasticity and walking distance at baseline did not differ significantly between the two groups. However, the severity of spasticity improved markedly in the BTA group,from 2.7 to 1.5 (Modified Ashworth Scale) at the hip adductor,and from 2.9 to 1.9 at the gastrocnemius at the 6-week follow-up. The walking distance improved from 46.17 m to 55.32 m at the 6-week follow-up, and to 66.6 m at the 12-week follow-up in the BTA group. Marked improvements in the quality of several gross motor functions were also noted in the BTA group. The improvements in spasticity,walking distance, and gross motor function were significantly greater in the BTA group than in the comparison group. The improvements in gait pattern did not differ significantly between the BTA and comparison groups. The findings of this study show BTA injection to be an effective treatment for reducing spasticity and improving gross motor function in children with spastic cerebral palsy. GMFM provides objective evidence regarding functional improvement after treatment in this patient population.
  SOURCE - J Formos Med Assoc 1999 Dec; 98(12):832-6

  AUTHOR - Wong V
  TITLE - Use of botulinum toxin injection in 17 children with spastic cerebral palsy.
  ABSTRACT - The use of botulinum toxin was studied in 17 children with spastic cerebral palsy to determine its efficacy and tolerability.Eleven ambulatory and 6 nonambulatory patients were included.All children were undergoing a physiotherapy program with monitoring of their baseline states for 3 months before botulinum toxin injection. The effect was evident within 72 hours. The peak effect was noticed by 1 to 2 weeks in the majority; the effect lasted for 3 to 10 months. All children experienced decreased spasticity scores. Their functional status improved, with three nonambulatory children becoming ambulatory with assistance and five children with assisted ambulation becoming more independently ambulatory.Measurement of joint motion showed improvement in the range of motion as compared with baseline. Video analysis of the functional state in the nonambulatory or gait in the ambulatory children revealed improvement in all. The functional status of rising from the sitting position or standing demonstrated improvement. None of the children had any untoward side effects except mild transient pain at the injection site. This study demonstrated botulinum toxin is useful as an adjunctive therapy in ameliorating spasticity in children with cerebral palsy, especially in the younger ones.
  SOURCE - Pediatr Neurol 1998 Feb; 18(2):124-31

  AUTHOR - Gordon N
  TITLE - The role of botulinus toxin type A in treatment--with special reference to children.
  ABSTRACT - Although botulinum toxin A was first introduced to treat strabismus and blepherospasm it is now used in an increasing number of conditions, many in the field of pediatrics. Its action results from a prevention of the release of acetylcholine from nerve terminals. A number of studies recording the effects of the toxin in the treatment of spastic cerebral palsy are reviewed, and although these can be criticized, there seems to be no doubt that it can be of benefit. It is few side effects, but it may reveal an underlying weakness. Other disadvantages are its cost and the need for repeated injections. It can be used for the relief of rigidity, although the effects in the extrapyramidal form of cerebral palsy are not so dramatic. Also it can be beneficial in some forms of dystonia, rarely if this is generalized, but certainly if it is focal, and especially if there is accompanying pain. There are several conditions seen in children, such as strabismus, blepherospasm and tremors, in which this form of treatment will rarely be indicated; but they will be mentioned. An exception may be spasmodic torticollis during adolescence if it does not respond to other therapy, as it is so disabling. Botulinum toxin can be used to block the discharges from cholinergic sympathetic and parasympathetic terminals. Focal hyperhidrosis can be very distressing among older children, and the use of the toxin should sometimes be considered in this and other autonomic disorders.
  SOURCE - Brain Dev 1999 Apr; 21(3):147-51

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