Treatment of spastic equinus gait with botulinum toxin A: Does dose matter? Analysis of a clinical cohort.

INTRODUCTION: This study reports the effects of various doses of BTX-A when treating equinus gait in cerebral palsy in a clinical setting at a tertiary hospital. PATIENTS: Twenty-nine children with CP (age 1.5-9.6 yrs, GMFCS I-IV) met the preset inclusion criteria. The treatment episodes per child ranged from 1 to 5 and the effects on a total of 80 legs in 55 treatment sessions were evaluated. METHODS: BTX-A doses injected into the gastroc-soleus muscle were divided into low- ( 6 units/kg bw) dose groups. The outcome measurements included active and passive ankle range of movement, Modified Ashworth Scale, dynamic muscle length, Selective Motor Control score, Observational Gait Scale score, and Goal Attainment Scale score at pre-treatment and 1, 2, and 4 months post-treatment. RESULTS: The only differences between the treatment groups were observed at 2 and 4 months in terms of change in passive ankle ROM and at 4 months in change in selective dorsiflexion, favouring the low-dose group. The incidence and severity of side-effects did not differ between the groups. CONCLUSION: Doses over 6 units/kg bw injected into the gastroc-soleus muscle do not necessarily yield superior results compared with lower doses.