Unbound MEDLINE

The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy.

Abstract

AIM
To study the long-term impact of 3 years of botulinum toxin A (BoNT-A) injections and abduction bracing on hip development in children with bilateral spastic cerebral palsy (CP). We wanted to know if early treatment improved hip development and reduced the need for surgery.
METHOD
A long-term review of hip morphology and surgery requirements in children who participated in a multicentre, randomized controlled trial. The trial investigated short-term effects of BoNT-A injections combined with an abduction brace, compared with usual care, on hip displacement in children with bilateral spastic CP.
RESULTS
Forty-six children with bilateral spastic CP (31 males, 15 females; 10 with diplegia, 36 with quadriplegia; mean age at enrolment of 3 y 2 mo, mean age at most recent clinical review 13 y 11 mo [range 10 y 6 mo-16 y 8 mo]; three children in Gross Motor Function Classification System level II, 11 in level III, 20 in level IV, 12 in level V) were followed for a mean of 10 years 10 months from recruitment to the trial. Mean migration percentage was 15.9% in the BoNT-A group and 15.2% in the comparison group (t = 0.26, p = 0.79). Eighty-nine percent of hips in the treatment group and 91% hips in the comparison group had satisfactory development, using a valid scale (Mann-Whitney U test = 867.50, z = -1.59, p = 0.11). Forty children had preventive surgery (21 treatment group, 19 comparison group) and 18 children had reconstructive surgery (10 treatment, 8 comparison).
INTERPRETATION
In children with bilateral spastic CP, early treatment with BoNT-A and hip abduction bracing does not reduce the need for surgery or improve hip development at skeletal maturity.

Links

  • Publisher Full Text

    • Authors

    Willoughby K, Ang SG, Thomason P, Graham HK

    Institution

    Orthopaedic Department, The Royal Children's Hospital, Parkville, Victoria, Australia. kate.willoughby@rch.org.au

    Source

    Developmental medicine and child neurology 54:8 2012 Aug pg 743-7

    MeSH

    Adolescent
    Botulinum Toxins, Type A
    Braces
    Cerebral Palsy
    Child
    Child, Preschool
    Combined Modality Therapy
    Female
    Hip
    Hip Dislocation
    Humans
    Injections
    Male
    Neuromuscular Agents
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    22686491