Botox may help improve movement in children suffering from cerebral palsy

A product that has made headlines for its use in enhancing beauty for the “not-so-young” may help improve movement in children suffering from cerebral palsy according to a University of Auckland PhD student.

Anna Mackey, from the Faculty of Medical and Health Sciences, is investigating the effects of botulinum toxin A, better known as Botox, when injected in the arm muscles of children with a particular form of cerebral palsy called hemiplegia.

Children with hemiplegia have muscle weakness predominantly on one side of the body, affecting both the arm and leg, while the limbs on the other side are normal.

A number of techniques have been successfully trialled for improving leg movement but there is a lack of scientific evidence in the literature on any form of intervention for the arm.

“Research shows that children usually favour the stronger hand and tend to ignore the hemiplegic hand in everyday activities. Due to limited therapy resources, the majority receive minimal intervention for their affected arm,” says Anna.

Botulinum toxin A has recently been introduced to assist in the management of muscle weakness and tightness associated with cerebral palsy.

“Localised injections of botulinum toxin A act to relax the tight muscle for up to four months, providing an excellent opportunity to improve function and delay the need for surgical intervention.

“The procedure has reversible effects and an excellent safety profile making it more appealing to use with younger children,” says Anna.

Use of botulinum toxin A is now an accepted form of treatment in the leg, but its use as a possible form of treatment in the upper limb has been minimal.

Earlier this year, Anna undertook a pilot study involving ten children with hemiplegia at The University of Auckland’s Gait Laboratory under the supervision of Associate- Professor Susan Stott and Dr Sharon Walt.

All children received botulinum toxin A injections in affected arm muscles at Starship Children’s Hospital, and were then followed up with a six-week therapy programme, to increase strength and encourage use of the arm.

A paediatric physiotherapist by training, Anna included strengthening exercises, functional activities, and made special splints to enhance hand function, as part of the therapy programme.

“I also encouraged children to work towards specific goals that they set for themselves, such as tying their own shoelaces, catching a rugby ball, or putting on nail polish,” says Anna.

Using three-dimensional movement analysis, the arm movements of children both before and after the botulinum toxin A injections were recorded and assessed. Regular check-ups for up to six months were built into the programme.

Six children have completed their six month follow-up and the other four have three months of post-treatment check-ups remaining.

Anna says the results so far have been encouraging.

“To date, we have found reduced muscle tightness and gains in movement in the arm muscles up to 12 weeks post the treatment. Preliminary results suggest more than 10 percent improvement in arm function.”

The ongoing follow-up of the four patients who are yet to complete the study will determine if these benefits can last up to six months after treatment.

“The advent of botulinum toxin A has provided families and clinicians with hope and a new treatment approach in the management of cerebral palsy. However, there are still questions that must be answered before we offer this treatment routinely. This study may take us some way to answering these questions.”

Anna’s study is funded by the Decade of Bone and Joint, The University of Auckland School of Medicine Foundation, and the New Zealand Neurological Foundation.