Effects of botulinum toxin injections on function and quality of life in children with cerebral palsy

Abstract

Our objective was to show the effects of botulinum toxin injections (BT) on function and quality of life in children with cerebral palsy (CP). 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). The average of the MAS was 2.5 for all injected muscles. Sixty-five percent 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. 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.