Does botulinum neurotoxin A make walking easier in children with cerebral palsy? A randomized clinical trial

Injections with botulinum neurotoxin A (BoNT-A) are frequently used as treatment of spasticity (increased muscle tone) in children with cerebral palsy (CP). However, the evidence of a functional effect, like improved walking, is insufficient.

The aim of this study was to investigate whether BoNT-A makes walking easier in children with CP. Energy cost during comfortable walking was used to assess ease of walking before and after treatment. We also wanted to investigate if walking capacity improved, habitual physical activity increased, and if leg pain was reduced. The children also reported self-perceived effect.

The study was a randomized controlled trial where the children were randomly allocated to receive either BoNT-A or saline water (placebo).

The results showed that one treatment with BoNT-A did not make walking easier compared to placebo within a time span of 12 weeks. However, a decrease in energy cost, twice as large as in the placebo group, was observed at 6 months follow-up. This suggests a possible delayed effect. On the other hand, we did not find any improvement in walking capacity or in habitual physical activity. However, there was some evidence that leg pain was reduced in children treated with BoNT-A.