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tone-reduction ankle-foot orthoses (AFOs).
2%
15/659
intramuscular injections of botulinum-A toxin.
7%
47/659
an intrathecal baclofen injection.
5%
35/659
selective posterior rhizotomy.
66%
433/659
fractional tendon lengthening of bilateral hamstring and gastrocnemius muscles.
19%
126/659
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Posterior rhizotomy provides a permanent reduction in tone of spastic muscles. Potential drawbacks of the procedure include excessive muscle weakness, hip dislocation, and spinal deformity. Intramuscular botulinum-A toxin results in permanent blockade of presynaptic release of acetylcholine across the neuromuscular junction. The clinical effect usually resolves after 3 to 6 months due to neural regeneration. Tone-reduction AFOs have not been shown to reduce tone. A baclofen pump could offer prolonged reduction in tone, but not a single intrathecal injection.
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