Botulinum toxin-A with and without rehabilitation for the treatment of spastic cerebral palsy

OBJECTIVE: To determine the efficacy of botulinum toxin-A (BTX-A) nerve block, with and without rehabilitation, in the treatment of spastic cerebral palsy. METHODS: Patients (aged 1-23 years) with spastic cerebral palsy underwent nerve block with BTX-A, followed by ≥ 2 h/day rehabilitation (experimental group) or <2 h/day rehabilitation (control group). Muscle tension and motor function were evaluated pre-block using the Modified Ashworth Scale (MAS) and gross motor function measure (GMFM), respectively. MAS was assessed weekly to determine duration of action of BTX-A; GMFM was assessed at 1 year post-block. RESULTS: There were no significant differences between the experimental group (n = 120) and the control group (n = 124) in age, body weight, pre-block MAS or GMFM, or BTX-A duration of action. MAS was significantly improved in both groups at 1 month post-block. At 1 year post-block, GMFM was significantly improved in both groups, with a significantly greater improvement seen in the experimental group compared with the control group. CONCLUSION: BTX-A block improved muscle tension and motor function. Rehabilitation training, following the block, resulted in greater improvements to motor function than block alone.