use of botulinum toxin and epidural analgesia for the treatment of spasticity and pain in a patient with maple syrup urine disease

ABSTRACT

A 7-year-old boy, weighing 18 kg, was diagnosed with maple syrup urine disease [MSUD]. He suffered from spasticity of the lower limbs and pain that did not respond to oral medications. Injections of botulinum toxin A [BTX-A] at 10 sites and epidural analgesia with 0.125% bupivacaine were used to treat spasticity with good results. We conclude that BTX-A combined with epidural analgesia may be a useful treatment option for incapacitating, painful spasticity related to MSUD. This treatment modality allowed a comprehensive rehabilitation program to be completed and it lasted longer than 9 months