AUDIT OF BOTOX INJECTION IN CEREBRAL PALSY CHILDREN 1st February 08 - 1st February 09 Wigan Dr T Win, Dr J Agbenu
Botox injection • Botulinum toxin type A – toxin produced by Clostridium botulinum. • Protein composed of heavy chain (molecular weight – 100,000) and light chain (50,000). • Heavy chain binds nerve terminal at neuromuscular junction. • Light chain is transported into the nerve terminals and blocks the release of Acetylcholine presynaptically, thereby weakening the force of muscle contraction.
Botox injection • An appropriate candidate for Botox injection will derive functional benefit from this- • Weakening of overactive agonist muscles should facilitate improve range of motion and limb function while rehabilitative exercises strengthen antagonist muscles and cultivate propioceptive map of the limb. • BOTOX – powder for reconstitution botulinum A neurotoxin complex. (100 units vial =GBP128.93)
Number of patients, Age, sex, type of CP • Number of patients who received Botox injection = 6 • Male : Female = 5 : 1 • Age • Age range - 3yr 10m to 12yr 6m • Type of CP - Spastic diplegia = 4 • Four limb CP = 2
Number of Botox injection received for each patient during audit period • 1 injection = 5 patients • 2 injections = 1 patient • (given to different sites in 6 months interval)
Number of patients who had previous Botox injections = 5 (83%) & intervals
Overall did the patient achieve desired outcome set prior to treatment? • Comments from clinic letters. • A) Increased mobility. • B) Good response to adductors, lesser extent to hamstrings, much better cared for hygiene. • C) Nappy change easier, less scissored, hip abduction 40-45 degrees. • D) Good effect, better sitting position, more strength, more ability to walk. • Physio assessment in community records.
Outcome • Continued treatment and follow up = 5 • Referral to AlderHey, for assessment of intrathecal Baclofen pump infusion = 2 • Referral to AlderHey orthopaedic Mr Bass for hips = 1 • Transfer (moving out) = 1