Muscle volume alterations after first botulinum neurotoxin A treatment in children with cerebral palsy: a 6‐month prospective cohort study

Alexander, Caroline; Elliott, Catherine; Valentine, Jane; Stannage, Katherine; Bear, Natasha; Donnelly, Cyril J.; Shipman, Peter; Reid, Sharon J.

doi:10.1111/dmcn.13988

Cited by 42 publications

(78 citation statements)

References 27 publications

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“…The rational of this treatment combination is that paralysis, followed by passive immobilization in a neutral position, results in tissue elongation through physiological adaptation to prolonged stretch. However, few clinical studies reported the effects of BoNT-A treatment at the muscle level (10)(11)(12)(13)(14)(15)(16)(17)(18). Synthesis of existing clinical studies that include post-treatment assessment of muscle morphology is hindered by methodological differences between studies and lack of normalization to account for natural muscle growth.…”

Section: Introductionmentioning

confidence: 99%

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

et al. 2020

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Botulinum NeuroToxin-A (BoNT-A) injections to the medial gastrocnemius (MG) and lower-leg casts are commonly combined to treat ankle equinus in children with spastic cerebral palsy (CP). However, the decomposed treatment effects on muscle or tendon structure, stretch reflexes, and joint are unknown. In this study, BoNT-A injections to the MG and casting of the lower legs were applied separately to gain insight into the working mechanisms of the isolated treatments on joint, muscle, and tendon levels. Thirty-one children with spastic CP (GMFCS I-III, age 7.4 ± 2.6 years) received either two weeks of lower-leg casts or MG BoNT-A injections. During full range of motion slow and fast passive ankle rotations, joint resistance and MG stretch reflexes were measured. MG muscle and tendon lengths were assessed at resting and at maximum dorsiflexion ankle angles using 3D-freehand ultrasound. Treatment effects were compared using non-parametric statistics. Associations between the effects on joint and muscle or tendon levels were performed using Spearman correlation coefficients (p < 0.05). Increased joint resistance, measured during slow ankle rotations, was not significantly reduced after either treatment. Additional joint resistance assessed during fast rotations only reduced in the BoNT-A group (−37.6%, p = 0.013, effect size = 0.47), accompanied by a reduction in MG stretch reflexes (−70.7%, p = 0.003, effect size = 0.56). BoNT-A increased the muscle length measured at the resting ankle angle (6.9%, p = 0.013, effect size = 0.53). Joint angles shifted toward greater dorsiflexion after casting (32.4%, p = 0.004, effect size = 0.56), accompanied by increases in tendon length (5.7%, p = 0.039, effect size = 0.57; r = 0.40). No associations between the changes in muscle or tendon lengths and the changes in the stretch reflexes were found. We conclude that intramuscular BoNT-A injections reduced stretch reflexes in the MG Peeters et al. Separate Effects of BoNT-A and Castingaccompanied by an increase in resting muscle belly length, whereas casting resulted in increased dorsiflexion without any changes to the muscle length. This supports the need for further investigation on the effect of the combined treatments and the development of treatments that more effectively lengthen the muscle.

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Section: Introductionmentioning

confidence: 99%

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

et al. 2020

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“…The impact of repeat dosing with BoNTA on muscle structure and function has not been studied in this paper but is recognised to be an important consideration in the long-term use of BoNTA. We have recently published on the impact on muscle volume and muscle structure following repeat dosing of BoNTA and presently we aim to minimise the dose of BoNTA used, rotate muscle selection where possible and ensure post intervention strength training, where appropriate [54][55][56]. It is now recognised that children with CP from socioeconomically disadvantaged settings are more likely to have reduced motor functional outcomes [57]; this study has not looked at any socio-economic determinants of health but this would be important in future research.…”

Section: Limitationsmentioning

confidence: 99%

A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term Botulinum toxin type A use

et al. 2020

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Background: The aim of this study is to contribute to the knowledge base on the long-term outcomes of evidence-based medical interventions used to improve gross motor function in children and adolescents with Cerebral Palsy. Method: Prospective cohort study of children with Cerebral Palsy in the birth years 2000-2009 attending a tertiary level service for children with Cerebral Palsy who's first recorded Gross Motor Function Classification System level was II. Results: A total of 40 children were eligible for the study, of whom 28 (72.7%) enrolled. The Botulinum toxin A treatment for this cohort, (median and interquartile ranges) were: total number of lower limb Botulinum toxin A injections 11 (6.7, 5.5); total dose of Botulinum Toxin A per lower limb treatment 6.95 u/kg (4.5, 11); and dose of Botulinum Toxin u/kg/muscle 2.95 (2.2, 4). For all 28 subjects there was a median of 15 (8.5 to 22) Gross Motor Function Classification System level recordings: six of the 28 children (21.4%) improved from level II to level I, the remaining 22 children remained stable at level II (78.6%). In this highly treated population, the average 66 item Gross Motor Function Measure score for the 22 children in level II was 72.55, which is consistent with the mean of 68.5 reported in the original Ontario cohort. Conclusion: This cohort study has confirmed that children with Cerebral Palsy, Gross Motor Function level II treated at a young age with repeated doses of Botulinum Toxin A within an integrated comprehensive service, maintain or improve their functional motor level at a later age. Background Cerebral Palsy (CP), the most common motor disorder of childhood, was described by Rosenbaum et al. in 2007 as a 'group of permanent disorders of the development of movement and posture that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain' [1, 2]. The Australian Cerebral Palsy Register has recorded the prevalence of CP as 2.1 per 1000 live births [3]. Perth Children's Hospital (PCH), Western Australia (WA) (population 2.4 million) is the state centre for the management of motor disorders in children and adolescents with CP. In 2003 following new funding from the West Australian government an evidence-based clinical program for children with CP in WA was established and is known as the Cerebral Palsy Mobility Service (CPMS). As part of the funding a database, the Paediatric Rehabilitation Information System (PRIS), was established, with retrospective data entry for children with CP to 1995 [4]. In a recent retrospective audit, we confirmed that the CPMS manages the state

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“…There has been great enthusiasm in recent decades about the results of BoNT-A application in the treatment of lower limb spasticity in ambulatory children with SCP, but new studies have pointed out some adverse effects. A study by Caroline et al revealed that atrophy of the injected muscle after first application of BoNT-A in the gastrocnemius muscle in children with SCP is greater in comparison with further applications, and hypertrophy is evident in the soleus after exposure of the gastrocnemius to BoNT-A (6).…”

Section: Botulinum Toxin Type a For Spastic Cerebral Palsy: Is It Timmentioning

confidence: 99%

Botulinum toxin type A for spastic cerebral palsy: Is it time to change praxis?

Čolović¹,

Dimitrijević²,

Stanković³

et al. 2020

J Rehabil Med

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Muscle volume alterations after first botulinum neurotoxin A treatment in children with cerebral palsy: a 6‐month prospective cohort study

Cited by 42 publications

References 27 publications

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy

A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term Botulinum toxin type A use

Botulinum toxin type A for spastic cerebral palsy: Is it time to change praxis?

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