Effects of botulinum toxin serotype A on sleep problems in children with cerebral palsy and on mothers’ sleep quality and depression

OBJECTIVE: To evaluate botulinum toxin serotype A (BoNT-A) effects on sleep problems in children with cerebral palsy (CP) and on mothers’ sleep quality and depression at multiple time points. METHODS: This is a single center, cross sectional, and observational study was conducted to assess children with CP who were admitted. We recruited children with CP who were admitted to Ministry of Health Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey between September 2012 and April 2014 for the BoNT-A injection for lower limb spasticity. Sleep quality of children with CP were determined at baseline and at the first, third and sixth month after the BoNT-A injection. Sleep quality Pittsburgh Sleep Quality Index (PSQI) and depression (by Beck Depression Inventory-II Turkish version) in mothers were also assessed. RESULTS: Twenty-four children with CP (7.05±2.69 years) underwent final assessment. Their bedtime resistance (11.71±3.26 versus (vs) 10±2.75, p<0.01), sleep anxiety (8.00±2.57 vs. 7.13±2.27, p=0.046) and daytime sleepiness (11.67±2.14 vs. 10.25±1.96, p<0.01) were significantly improved in the first month after the BoNT-A injection. In accordance with this, PSQI and BDI scores of the mothers decreased in the first month after the BoNT-A injection. Thereafter, BDI scores continued to decrease, whereas PSQI slightly increased in the third month. CONCLUSIONS: The BoNT-A injection for spasticity in children with CP may have the potential to improve sleep quality in children with CP and their primary caregiver, the mother, as well as to reduce depression in the mother.