Affiliations: Department of Neuropediatrics and Muscular Disorders,
Children's Hospital, University of Freiburg, Germany | Children's Hospital, University of Munich,
Germany | Department of Orthopedics, Munich-Harlaching Hospital,
Germany
Note: [] Correspondence: Volker Mall, M.D., Zentrum für
Kinderheilkunde und Jugendmedizin Klinik II: Neuropädiatrie und
Muskelerkrankungen, Mathildenstraße 1, 79106 Freiburg, Germany. Tel: + 49
761 270 43 01; fax: + 49 761 270 43 44; E-mail:
[email protected].
Abstract: Several controlled studies have shown that in children with cerebral
palsy, botulinum toxin A (BTX/A) can decrease muscular hyperactivity associated
with spasticity and improve function. Studies have hitherto focused on the
dimensions of impairment and functional limitations. In this pilot study with
BTX/A in children with cerebral palsy, we used the Pediatric Evaluation of
Disability Inventory (PEDI) to evaluate the effect of treatment. PEDI is a
reliable and valid instrument that focuses on assessing disability in daily
life. Patients with cerebral palsy (n = 17, median age 5.5 years, age range 2.5
to 16.5 years) were treated with BTX/A for pes equinus (n = 8) or adductor
spasm (n = 9). PEDI assessment was carried out before and 1 month after the
first treatment with BTX/A. Scaled scores were calculated according to the
user's manual for the Mobility domain with scores near "0" reflecting low
capability and scores near "100" reflecting high capability. We found a
significant improvement in the mobility domain-caregiver dimension from 52.3%
± 26.6% to 56.6% ± 26.7% (mean, standard deviation P < 0.05),
as well as in the self care domain-functional skills from 63.6% ± 18.7%
to 65.2% ± 19.6% (mean, standard deviation P < 0.05). Our data
indicate that in young patients with cerebral palsy, BTX/A therapy of the lower
extremity can reduce the disability. For these patients PEDI is a valuable
assessment instrument that reflects the effect of treatment with BTX/A on the
disability. (J Pediatr Neurol 2003; 1(1): 29–34).
Keywords: Botulinum toxin A, cerebral palsy, therapy evaluation evaluation, Pediatric Evaluation of Disability Inventory, PEDI
