Building the case for Botox, step by step

Like any five-year-old, Chantel Azevedo likes to be on the move.

But until recently, getting around was difficult. That’s because cerebral palsy made her right leg muscles stiff, pulling her heel off the floor. “You can imagine how hard it would be to walk everywhere on tip-toe,” her mom Vicky says. “It knocked her balance off and made her fall.”

That changed dramatically when Chantel had Botox injections to treat the stiffness – known as spasticity – at Bloorview. “She was able to put her foot flat on the ground, which meant she could walk and run better, play jumprope better, alternate her legs climbing stairs, and do all the things five-yearolds like to do.”

Bloorview was one of the first hospitals in North America to use Botox to treat spasticity in children, conducted one of the first randomized trials to show its efficacy, and uses the treatment in over 400 children each year. The drug temporarily blocks abnormal brain signals that cause muscles to contract.

Dr. Darcy Fehlings, physician director of Bloorview’s child development program and head of the University of Toronto Division of Developmental Pediatrics, has just embarked on the first study to look at the long-term impact of Botox on motor function and participation.

“We want to see if the short-term gains we see in function translate into a richer, everyday quality of life over the long-term,” says Darcy. “Are kids able to take more steps, participate in more recreation activities, and move around in the community more easily?”

About 180 children, aged two to five, will be followed over three years.

Dr. Darcy Fehlings is part of an international group of specialists who developed a consensus statement on the medical uses of botulinum toxin based on an extensive review of the scientific literature. Findings of the review on treating upper-limb spasticity in children – which Darcy led – will be published in the European Journal of Neurology.

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