The effect of botulinum toxin A on gastrocnemius length: magnitude and duration of response

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Abstract
Thirty‐nine ambulant children (22 with hemiplegia, 17 with diplegia) with spastic cerebral palsy receiving isolated gastrocnemius muscle injection with botulinum toxin A were studied prospectively. The children had a mean age of 6 years (range 3 to 13 years). Measurement of gastrocnemius muscle length was used to estimate the dynamic component of each child's spasticity and to quantify the response. There was a strong correlation between the dynamic component of spasticity before injection and the corresponding magnitude of the response after injection. Children undergoing repeated injections showed similar correlations. A strong correlation was found between the duration of response and the dynamic component. Children with hemiplegia showed twice the duration for a given dynamic component compared with those with diplegia when injected with the same total dose per unit body weight. Long‐term lengthening did not occur for the cohort, although some patients showed a response at a 12‐month follow‐up. By delaying shortening, the injections may have a role in delaying the need for surgery. Injections were well tolerated with few side effects.

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