May 1 2004
Botox, or botulinum toxin, offers a new, non-surgical option for improving the upper extremity function of children with cerebral palsy (CP), report researchers from Wake Forest University Baptist Medical Center. L. Andrew Koman, M.D., orthopedic surgeon at Brenner Children’s Hospital, and his team recently completed a study using Botox to treat muscle spasticity of the arm and hand in children with CP. In 1998, Koman and his team were the first worldwide to use Botox to treat muscle spasticity in CP patients.
Koman injected 73 cerebral palsy patients with either Botox or a placebo to see if Botox injections would help the muscles in a patient’s upper extremities relax, allowing them to grasp objects, play sports or do many daily functions they were previously unable to do. The Botox group showed three times the improvement in functional ability as compared to the group who received the placebo. He presented his results at the American Academy of Pediatrics’ annual meeting in San Francisco on Saturday.
“Of the 500,000 people affected with CP in the United States, more than half have upper extremity impairments,” Koman said. “Less than 20 percent of those can be helped with surgery. This non-surgical intervention is the one way to improve functional outcomes for these patients, decrease pain and facilitate care.”
Koman and his team have been studying the effects of Botox on CP patients since 1988.
CP is caused by an injury to the developing central nervous system during or shortly after birth. The disease causes the brain to send abnormal messages to muscles in the arms and legs, causing them to stiffen and contract (muscle spasticity). Patients with CP often have difficulty dressing themselves, brushing their teeth or eating with utensils. By injecting the muscles with Botox, the muscles relax and improve a patient’s ability to perform some of their daily activities.
“This is a huge help not only to the patient but to the caregiver, who may have trouble dressing the patient or getting the child into a car seat,” Koman said.
Most patients experienced peak effect in one to two days after receiving the injections. The injections must be repeated anywhere from three to six months as the toxin wears off. Results vary from patient to patient depending on the severity of the disease. In addition, many of the children need fewer shots over time, are able to lengthen the time between injections, and even stop the injections completely, Koman said.
“Many of our patients come back into the office asking for additional injections because they are thrilled with the results,” he said. “Once the muscles have relaxed, patients can undergo therapy to strengthen weak muscles. Botox injections work very well in conjunction with other treatments.
“The only side effect is soreness at the injection site,” Koman said. “This is a safe, selective, reversible, repeatable treatment option that can be used in conjunction with other treatments.”
Koman was recently awarded the Arthur H. Huene Memorial Award for excellence and promise in pediatric orthopaedics for his research. He plans to use the grant monies to continue his work with Botox and to explore brain reorganization in children with CP.