Botulinum Toxin - Case Study
Botox® to treat spasticity related to stroke
A 10-year-old boy had a left cerebral hemorrhage secondary to idiopathic thrombocytopenia purpura. As a result of the stroke, he developed right spastic hemiplegia.
Significant lower extremity spasticity resulted in the development of a severe plantarflexion contracture in his right ankle. This prevented him from standing on his foot because of pain and poor foot position. He did not tolerate range-of-motion exercises or bracing. Serial casting was tried but provided minimal short-lived benefits. Three months after his stroke, the boy could walk no more than a few feet using a walker and with maximum assistance from another person.
Because his spasticity and contracture were resistant to conservative management, more aggressive measures were considered. However, the boy's bleeding disorder ruled out surgery as an option. The spasticity evaluation team at Gillette Children's recommended Botox® injections be given into the patient's gastrocnemius soleus muscle and posterior tibialis muscles, followed by serial casting of the ankle.
This resulted in a significant reduction in spasticity, improved range of motion and marked gains in rehabilitation therapy. One month after treatment, the boy was walking independently using a quad cane.
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| Before Botox® | After Botox® |
