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Abstract

We appreciate the interest and the comments by Dr. Dai regarding our meta-analysis on botulinum toxin in equinus foot. Dr. Dai stresses important points to all physicians who inject botulinum toxin type A (BTX-A), which are the different doses reported in the literature, and the occurrence of side effects after BTX-A injection. In Table 1 we can observe the doses used in the papers of our meta-analysis [ 1 Russman B.S. Tilton A. Gormley Jr, M.E. Cerebral palsy: A rational approach to a treatment protocol, and the role of botulinum toxin in treatment. Muscle Nerve Suppl. 1997; 6: S181-S193 Crossref PubMed Google Scholar , 2 Baker R. Jasinski M. Maciag-Tymecka I. et al. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: A randomized, double-blind, placebo-controlled, dose-ranging study. Dev Med Child Neurol. 2002; 44: 666-675 Crossref PubMed Google Scholar , 3 Koman L.A. Mooney 3rd, J.F. Smith B.P. Goodman A. Mulvaney T. Management of spasticity in cerebral palsy with botulinum-A toxin: Report of a preliminary, randomized, double-blind trial. J Pediatr Orthop. 1994; 14: 299-303 Crossref PubMed Scopus (295) Google Scholar , 4 Koman L.A. Brashear A. Rosenfeld S. et al. Botulinum toxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: A multicenter, open-label clinical trial. Pediatrics. 2001; 108: 1062-1071 Crossref PubMed Scopus (138) Google Scholar , 5 Love S.C. Valentine J.P. Blair E.M. Price C.J. Cole J.H. Chauvel P.J. The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia: A randomized controlled trial. Eur J Neurol. 2001; 8: 50-58 Crossref PubMed Scopus (107) Google Scholar , 6 Sutherland D.H. Kaufman K.R. Wyatt M.P. Chambers H.G. Mubarak S.J. Double- blind study of botulinum A toxin injections into the gastrocnemius muscle in patients with cerebral palsy. Gait Posture. 1999; 10: 1-9 Abstract Full Text Full Text PDF PubMed Scopus (191) Google Scholar ]. As we can see, they ranged from 15 to 30 units of Dysport, and 1 to 7.3 units of Botox. Botulinum Toxin Type A in the Management of Cerebral Palsy: Low or High Dose?Pediatric NeurologyVol. 35Issue 6PreviewWe read with interest the recently published study by Cardoso et al. describing the data of published double-blind, randomized clinical trials to assess, with a meta-analysis, if botulinum toxin type A is an adequate treatment for spasticity caused by cerebral palsy [1]. We agree with the authors in that the clinical effects of botulinum toxin type A (BTX-A) have been reported to include decreased spasticity and increased range of motion. It can be one of the main tools to improve prognosis in children with cerebral palsy. Full-Text PDF