Treatment of Lateralisation and Subluxation of the Hip in Cerebral Palsy with Botulinum Toxin A: Preliminary Results Based on the Analysis of Migration Percentage Data

Abstract

It has been reported that cerebral palsy patients with adductor spasm and lateralisation/subluxation of the hip can be treated with Botulinum toxin A, but statistical evaluation is lacking. We present the radiological results in 5 patients. The follow-up ranged from 18 (5 patients) to 24 months (4 patients). Reimers' migration percentage was chosen as parameter for lateralisation/subluxation. Statistical analysis was performed by the Wilcoxon test. The migration percentage improved from 51 % to 44 % at 9 months, 37 % at 18 months, and 34 % at 24 months. The improvement was significant from the 9th to the 18th month (p = 0.04).

Key words

Cerebral palsy - hip lateralisation/subluxation - adductor spasm - Botulinum toxin A (Btx-A)

References

• 1 Boyd R N, Britton T C, Robinson R O, Borzyskowski M. Transient urinary incontinence after Botulinum A toxin.  Lancet. 1996;  348 481-482
• 2 Boyd R N, Dobson F, Parrot J, Love S, Oates J, Larson A, Burchall G, Chondros P, Carlin J, Nattrass G, Graham H K. The effect of botulinum toxin type A and a variable hip abduction orthosis on gross motor function: a randomised controlled trial.  Eur J Neurol. 2001;  8 (Suppl 5) 109-119
• 3 Corry I S, Cosgrove A P, Walsh E G. et al . Botulinum toxin A in the hemiplegic upper limb: a double-blind trial.  Dev Med Child Neurol. 1997;  39 185-193
• 4 Deleplanque B, Lagueny A, Flurin V, Arnaud C, Pedespan J M, Fontan D, Pontallier J R. Botulinum toxin in the management of spastic hip adductors in non-ambulatory cerebral palsy children.  Rev Chir Orthop Reparatrice Appar Mot. 2002;  88 279-285
• 5 Fehlings D, Rang M, Glazier J. et al . An evaluation of botulinum toxin A injections to improve upper extremity function in children with hemiplegic cerebral palsy.  J Pediatric. 2000;  137 331-337
• 6 Garner C G, Straube A, Witt T N, Gasser T, Oertel W H. Time course of distant effects of local injections of botulinum toxin.  Mov Disord. 1993;  8 33-37
• 7 Heinen F, Wissel J, Mall V, Philipsen A, Leititis J U, Bernius P, Stücker R, Korinthenberg R. Interventionelle Neuropädiatrie. Behandlungsmöglichkeiten mit Botulinumtoxin A. Boltshauser E, Schmitt B, Steinlin M Aktuelle Neuropädiatrie 1996. Nürnberg; Novartis Pharma Verlag 1996: 251-259
• 8 Kirschner J, Berweck S, Korinthenberg R, Heinen F. Behandlung mit Botulinumtoxin.  Dt Ärztebl. 2001;  98 A3375-3379
• 9 Koman L A. Mooney 3rd JF . Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy. A randomised, double blind, placebo-controlled trial.  J Pediatr Orthop. 2000;  20 108-115
• 10 Konstanzer A, Ceballos-Baumann A O, Dressnandt J, Conrad B. Lokale Injektionsbehandlung mit Botulinumtoxin A bei schwerer Arm- und Beinspastik.  Nervenarzt. 1993;  64 517-523
• 11 Mall V, Heinen F, Kirschner J. Evaluation of botulinum toxin A therapy in children with adductor spasm by gross motor function measure.  J Child Neurol. 2000;  15 214-217
• 12 Philipsen A, Heinen F, Scheidt C E, Korinthenberg R. Psychosoziale Veränderungen unter Langzeitbehandlung mit Botulinumtoxin A. Boltshauser E, Schmitt B, Steinlin M Aktuelle Neuropädiatrie 1996. Nürnberg; Novartis Pharma Verlag 1996: 260-263
• 13 Placzek R, Meiss L. Behandlung mit Botulinumtoxin A innerhalb und außerhalb der Standardindikationen.  Osteologie. 2001;  10 (Suppl 2) 69
• 14 Reimers J. The stability of the hip in children. A radiological study of the results of muscle surgery in cerebral palsy. Copenhagen, Århus, Odense; FADLs Forlag 1980
• 15 Scrutton D, Baird G. Surveillance measures of the hip of children with bilateral cerebral palsy.  Arch Dis Child. 1997;  76 381-384
• 16 Ubhi T, Bhakta B B, Ives H L. et al . Randomized double-blind, placebo-controlled trial of the effect of botulinum toxin on walking in cerebral palsy.  Arch Dis Child. 2000;  83 481-487
• 17 Wissel J, Heinen F, Schenkel A. et al . Botulinum toxin A in the management of spasticity gait disorders in children and young adults with cerebral palsy: a randomized, double-blind study of “high-dose” versus “low-dose” treatment.  Neuropediatrics. 1999;  30 120-124