Global Advanced Research Journal of Medicine and Medical Sciences (GARJMMS) ISSN: 2315-5159
December 2015 Special Issue Vol. 4(12), pp. 525-532
Copyright © 2015 Global Advanced Research Journals

Full Length Research Paper

Efficacy of Multilevel Botox A Injection in Hemiplegic and Diplegic Spastic Cerebral Palsy: A Clinical and Neurophysiological study

Nayera Z. Saber* and Dalia M E El Mikkawy

Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Ain Shams University

*Corresponding Author E-mail: norazaghloul@yahoo.com; Telephone:  + 2 01117288825

Accepted 04 December, 2015

Abstract

Spasticity in cerebral palsy places obstacles in the path to achieving the rehabilitation goals. Aiming to detect favorable outcomes of multilevel Botox A injection in spastic (cerebral palsy) CP children at a single session from clinical and electrophysiological aspects and to localize dependable factors for those outcomes. Twenty two spastic CP patients with lower limbs spasticity were enrolled. All  patients were assessed by modified Ashworth scale (MAS), Timed 10 meter walk (TMW), Pain scale, knee and ankle ROM. Also F wave, and H reflex with F/M and H/M amplitudes and gastrocnemius (Gas) surface EMG (SEMG) for interference pattern (IP) recording. Multilevel Botox injection of Gas, Soleus, Hamstring (Ham), and Tibialis posterior muscles was done in single session. Reassessment at 1, and 6 months. Fourteen patients were diplegic and 8 were hemiplegic, 12 males and  10 females. There was significant increase in knee and ankle ROM (P˂ 0.01) at 1 and 6 months post injection. MAS,TMW and Pain scale, F/M and H/M amplitude were significantly reduced, and significant improvement of IP one month after injection which persist till the end of study. A significant negative correlation existed between MAS of (Gas Sol and Ham) at 6 month and baseline ROM ankle and knee (P ˂ 0.05) and between MAS Gas and interference pattern (P = 0.04). ROM knee, amplitude of H/M and F/M were dependable factors for improved TMW after 6 months (TMW2) as a secondary outcome at the end point of the study. Multilevel Botox A injection reduces spasticity, and improves the short and long term outcomes. Both clinical (ROM, TMW) and neurophysiological measures (F/M, H/M, SEMG) were useful assessment tools for monitoring response to treatment.

Keywords: Cerebral palsy, spasticity, Botox A injection, Ashworth score, F wave, H reflex