gms | German Medical Science

Objectives/Interrogation: Many studies report the outcome of hand function after treatment with botulinum toxin type A injection in the management of spastic CP deformities. Upper limb surgeries in carefully selected cerebral palsy patients as surgical interventions tend to improve their activities of daily living and quality of life. The aim of this study was to review our results of management of upper limb deformities in cerebral palsy patients with a view to using botulinum injections as a prediction of surgical outcomes.

Methods: This was a retrospective review of 25 consecutive CP patients who had intramuscular botulinum toxin type A injection (Botox® (BTX-A), Allergan, Ireland) or surgical correction or both for spastic deformities of the upper limbs from June, 1982 to October, 2010 at the Duchess of Kent Children Hospital (DKCH). There was no standardised management protocol as treatment was tailored to meet the specific needs of each patient in terms of dose of BTX-A injection, sites of intramuscular injection, interval between doses, number of injections, physical therapy sessions, types of splints used and required number and nature of surgical procedures needed.

Results and Conclusions: For group A (n=13), the mean increase in AROM of the wrist joint was 21.15 degrees while for group B (n=9), it was 60.56 degrees (t=2.850; p 0.010). In group A (n=15), the mean increase in the House score was 1.27 as against that of group B (n=10) which was 2.10 (t=1.287; p 0.211).

The use of BTX-A injection and surgical interventions are beneficial to CP patients with spastic upper limb deformities, when indicated, as evidenced by the improvement in the range of motion of a joint and functional outcome of the upper limbs using the HFCS.

The long term benefit of surgical correction (with BTX-A injection) in improving the AROM of the wrist joint is at least three times better than that obtained from BTX-A injection alone.