Medial gastrocnemius volume and echo-intensity after botulinum neurotoxin A interventions in children with spastic cerebral palsy.

Abstract

AIM:

This cross-sectional investigation evaluated whether recurrent botulinum neurotoxin A (BoNT-A) interventions to the medial gastrocnemius have an influence on muscle morphology, beyond Gross Motor Function Classification System (GMFCS) level.

METHOD:

A cohort of typically developing children (n=67; 43 males, 24 females; median age 9y 11mo [range 7y 10mo-11y 6mo]), a cohort of children with spastic cerebral palsy (CP) naive to BoNT-A interventions (No-BoNT-A; n=19; 10 males, nine females; median age 9y 3mo [range 8y 5mo-10y 10mo]) and a cohort of children with spastic CP with a minimum of three recurrent BoNT-A interventions to the medial gastrocnemius (BoNT-A; n=19; 13 males, six females; median age 9y 8mo [range 7y 3mo-10y 7mo]) were recruited. Three-dimensional freehand ultrasound was used to estimate medial gastrocnemius volume normalized to body mass and echo-intensity.

RESULTS:

Normalized medial gastrocnemius volume and echo-intensity significantly differed between the two spastic CP cohorts (p≤0.05), with the BoNT-A cohort having larger alterations. Associations between normalized medial gastrocnemius volume and echo-intensity were highest in the No-BoNT-A cohort, followed by the BoNT-A cohort. Multiple regression analyses revealed that both GMFCS level and BoNT-A intervention history were significantly associated with smaller normalized medial gastrocnemius volume and higher echo-intensity.

INTERPRETATION:

Recurrent BoNT-A interventions may induce alterations to medial gastrocnemius volume and echo-intensity beyond the natural history of the spastic CP pathology.

WHAT THIS PAPER ADDS:

In spastic cerebral palsy, medial gastrocnemius volumes are smaller and echo-intensities higher compared with typical development. Alterations after botulinum neurotoxin A intervention (BoNT-A) are larger than in no BoNT-A intervention. Gross Motor Function Classification System level and BoNT-A history significantly associate with medial gastrocnemius and echo-intensity alterations.

• Authors: Simon-Henri Schless, Francesco Cenni, Lynn Bar-On, Britta Hanssen, Barbara Kalkman, Thomas O'brien, Erwin Aertbeliën, Anja Van Campenhout, Guy Molenaers, Kaat Desloovere
• Journal: Developmental medicine and child neurology (Dev Med Child Neurol) Vol. 61 Issue 7 Pg. 783-790 (07 2019) ISSN: 1469-8749 [Electronic] England
• PMID: 30320442 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 Mac Keith Press.

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Botulinum Toxins, Type A (administration & dosage)
• Cerebral Palsy (complications, drug therapy, pathology, physiopathology)
• Child
• Cohort Studies
• Female
• Humans
• Imaging, Three-Dimensional
• Injections, Intramuscular
• Leg
• Male
• Muscle Spasticity (drug therapy, etiology, pathology, physiopathology)
• Muscle, Skeletal (diagnostic imaging, drug effects, pathology)
• Neuromuscular Agents (administration & dosage)
• Organ Size
• Treatment Outcome
• Ultrasonography