Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012 Mar; 156(1):41–47. 41 Estimation of botulinum toxin type A efficacy on spasticity and functional outcome in children with spastic cerebral palsy Hristina Colovic a , Lidija Dimitrijevic a,b , Ivona Stankovic a,b , Dejan Nikolic c , Dragana Radovic-Janosevic b,d Aim. We evaluated the effects of botulinum toxin type A (BTA) – abobotulinumtoxinA on passive motion resistance (PMR) values of lower limbs affected muscles and on the functional motor status in children with spastic cerebral palsy (CP). Methods. In Group I (28 lower limbs with spastic muscles), and in Group II (14 lower limbs with dynamic spastic equinus) BTA was administered. Physical therapy was prescribed for 16 weeks. We estimated PMR using the Modified Ashworth Scale. Achieved functional motor level was evaluated by Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM). Parameters were assessed before treatment and after 3,8,16 weeks and 6 months respectively. Results. In Group I, PMR was significantly lower for hip adductors and knee extensors over 3-16 weeks, and for ankle joint extensors in both groups. There were significant differences for both groups in frequencies of GMFCS values after 16 weeks from BTA application. There was a significant increase in GMFM scores after 8 and 16 weeks from BTA application in both groups of patients. Conclusions. BTA treatment in CP children is followed by reduction in PMR values and improvement in functional motor status. Key words: cerebral palsy, spasticity, children, botulinum toxin, physical, therapy Received: September 30, 2011; Accepted with revision: January 27, 2012; Available online: February 17, 2012 http://dx.doi.org/10.5507/bp.2012.017 a Clinic for Physical Therapy and Rehabilitation, Clinical Centre of Nis, Nis, Serbia b Faculty of Medicine, University of Nis, Nis, Serbia c Physical Medicine and Rehabilitation, University Children’s Hospital, Belgrade, Serbia d Gynecology and Obstetrics Clinic, clinical Centre of Nis, Nis, Serbia Corresponding author: Hristina Colovic, e-mail: ninacol40@ymail.com INTRODUCTION Cerebral palsy (CP) is a group of developmental disor- ders of movement and posture, causing activity limitation, that are attributed to a non-progressive disturbances in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/ or behavior, and/or by a seizure disorder 1 . The most fre- quent presentation of neurological impairment in CP is spasticity with most pronounced effect on skeletal mus- cles (70-80%), where heterogeneity of clinical phenotypes is the dominant characteristic 2,3 . Affected muscles usually present with fewer myofibrils and their decreased longi- tudinal length. Studies have demonstrated that decrease in the longitudinal length of myofibrils of 50% leads to the onset of contractures and fixed deformities of the skeletal-joint system 4-7 . In the spastic type of CP, contrac- tures are present in early stages. Therefore, even though spasticity is primarily present, the majority of children have combined clinical presentation of spasm and con- tracture 8 . Regarding the therapy approach, it is important to distinguish 2 types of contractures: dynamic (in young- er children, where reduction in joint movement range is due to the spasm of affected muscles) and fixed (in older children with limitation in joint movement range) (ref. 8 ). The therapy approach for spastic muscles and dynamic contractures include application of botulinum toxin (BT), physical therapy and orthoses 2 . In human medicine, BT is most frequently used as BT type A (BTA) that is com- mercially available as Dysport ® (Ipsen Ltd, Slough, UK) (abobotulinumtoxinA – ABO), BOTOX ® (Allergan Pty Ltd) (onabotulinumtoxinA – ONA) and Xeomin ® (Merz Pharmaceuticals) (ref. 2,9,10 ). The consensus regarding the application of BTA in the therapy of lower limbs spasticity in children with spas- tic type of CP is based on analyses of numerous reports and studies from the International Committee for BTA therapy 2 . It is noticed that BTA injection is an effective treatment for spasticity of lower limbs in CP patients and should be combined with physical therapy and orthoses. Previous reports state that higher quality of outcome in- volves accurate measures of quantitative and qualitative parameters. Since, there is no single unit consolidating both parameters it is recommended that outcome mea- sures should include at least one objective parameter that refers to local response to BTA application and at least one functional parameter 2,11 .Therefore, the aim of our study was to evaluate the effects of BTA – ABO applica- tion on passive motion resistance (PMR) values of af-