TORONTO, Apr 19 (Reuters Health) -- Botulinum toxin type A -- or Botox, the substance used by dermatologists to banish forehead wrinkles -- can help some children with cerebral palsy to walk with the aid of crutches, researchers from the Czech Republic reported Monday at the American Academy of Neurology meeting.
Dr. Peter Kanovsky of University Hospital at Masaryk University in the Czech Republic and colleagues announced that even in children with severe cerebral palsy, botulinum toxin A injections can reduce the spasticity or muscle stiffness characteristic of the syndrome. Together with physiotherapy, the injections can lead to such improvement that some children who could not attempt walking can begin to walk with the aid of crutches.
Twenty-seven non-ambulatory children with cerebral palsy between the ages of 2 to 7 years were recruited for the study, which followed the children's progress for over two years. Investigators specifically treated children with spasticity affecting their leg muscles, "muscles needed for verticalization," Kanovsky said in an interview with Reuters Health.
At follow-up, Kanovsky and colleagues assessed results from the combined approach of intensive physiotherapy and a series of botulinum toxin A injections, using a variety of scales for motor function (walking) graded from zero (no improvement) to four (verticalization without aids).
"No child achieved the category four level," Kanovsky said, but he saw some difference in motor function in seven children. Fourteen others achieved what Kanovsky described as "motor milestones." He explained that a motor milestone was any change in motor function identified by physiotherapists as the next stage of achievement for the child.
The remaining six children all achieved verticalization with aids, "meaning they could stand and achieve a gait," Kanovsky noted. He said that he and his colleagues are continuing to treat these children, and they expect to achieve "a high level of improvement" in about half of the group overall.
The study also confirmed the safety of using botulinum toxin in these patients, the researchers report.
Botulinum toxin A injections are about as painful as a regular vaccination. However, children do find them stressful and they are perceived as painful, Kanovsky said.
Various forms of local anesthesia have been tried, but so far "the best anesthesia is still a very quick injection into the proper site," he added.
Botulinum toxin A reduces spasticity by inhibiting the release of acetylcholine, a chemical that carries messages from nerve to muscle. Reducing the concentration of this chemical messenger weakens the muscle and decreases spasticity. Effects of the toxin last about three months on average, after which the muscle tone again increases.
