Effect of Botulinum Toxin a on Spasticity and Function in Children with Cerebral Palsy: A Systematic Review

Abstract: The term cerebral palsy (CP) refers to a group of non-progressive developmental and postural disorders caused by a brain malformation or lesion. Botulinum toxin A (BT-A) combined with physical therapy has been used to diminished spasticity in children with CP, leading to an improvement in quality of life. The aim of the present systematic review was to evaluate the effect of BT-A on spasticity and function in children with CP.
Searches were performed in a virtual library network as well as in Medline, Embase, PEDro, Lilacs, Scielo, and PubMed databases from December 2012 to August 2013 for articles published between 2006 and 2013 in Portuguese, English, or Spanish. The inclusion criteria were: 1) controlled trial, 2) children and adolescents with spastic CP, 3) use of BT-A to reduce spasticity, 4) physical therapy or use of plaster casts combined with BT-A, and 5) analysis of improvement in motor function. Data were extracted from the articles based on a previously determined standardized protocol.
Six controlled trials addressing the effect of BT-A combined with either physical therapy or plaster casts were found. The articles received at least 3 points based on the PEDro criteria of methodological quality. All papers reported improvements in spasticity, especially among children classified at levels I, II, or III of the Gross Motor Function Classification System with no established deformities.
The use of BT-A combined with either physical therapy or plaster casts leads to improvements in motor function, gait, proprioception, and muscle strength in children with CP. However, long-term studies are needed to determine whether the improvement in function is maintained after the return of the spasticity.

Keywords: physical therapy, botulinum toxin, Cerebral Palsy