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Botox shots may help kids with cerebral palsy

NEW YORK (Reuters Health) - As a treatment for muscle stiffness in children with cerebral palsy, shots of botulinum toxin A, best known by the brand name Botox, are safe and produce measurable improvements in function, according to a new study. However, patients and their families may not perceive the improvements as very meaningful.

The muscles of people with cerebral palsy are often stiff, contract spontaneously and over-react to stimulation, a characteristic called spasticity. Injection of Botox helps to reduce spasticity and allows the person a greater degree of control over muscle movement.

Since the first report on the use of Botox to treat spasticity in children with cerebral palsy was published in 1993, there have been more than 100 articles addressing the intervention, note Dr. Kristie Bjornson, of Children’s Hospital and Regional Medical Center in Seattle, and colleagues. However, impact of the treatment has been difficult to assess because of the scarcity of reliable measures of spasticity and problems in measuring changes in function in children with disabilities.

In a controlled study, Bjornson’s team examined the effects of Botox shots versus placebo in 33 children with spastic diplegia -- a form of cerebral palsy where both the arms and legs have abnormal stiffness. Outcomes were measured at baseline and 3, 8, 12, and 24 weeks after injection.

Overall, results showed that the physiologic and mechanical effects of treatment with Botox are “genuine and measurable” in children with spastic diplegia cerebral palsy.

“However, these effects may not create enough change in the patients’ function or the families’ perception of function to register as a meaningful improvement in their societal participation,” the authors note.

“It is possible that these changes were too subtle to be recognized with conventional satisfaction measures,” they write.

The investigators say their findings suggest that expectations about Botox shots should be realistic.

SOURCE: Pediatrics July 2007.