From the Institute for Child Development and Pediatric Neurology Unit

We sought markers for predicting a favorable outcome of botulinum toxin A injected to the lower-extremity muscles of 26 children with hemiplegic or diplegic cerebral palsy. Clinical assessment preceding and 1 month following injection included gross motor function measure, a modified Ashworth scale, and evaluation of range of motion of knee extension and ankle dorsiflexion. Response to treatment was classified based on a parent questionnaire. The 19 children (73%) considered by their parents as being good responders were compared to the 7 (27%) considered as being poor responders. In the good responders, the preinjection Ashworth scale (spasticity) was significantly higher (P <.05) and gross motor function mea-sure scores (function) were lower (P <.05). Sixty-eight percent of the good responders were nonindependent walkers compared to 14 % of the poor responders (P <.05). There were no differences in age, type of cerebral palsy, and dose of injection. An Ashworth scale indicating increased muscle tone, lower gross motor function measure scores, and nonin-dependent ambulatory status were predictive for a favorable response to botulinum toxin A injections and can guide patient selection and expectations of treatment outcome. (J Child Neurol 2002;17:272-277). Since 1990, botulinum toxin A, a reversible neuromuscular blocking agent, has increasingly been used for the treatmen