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- Title
Medial gastrocnemius volume and echo-intensity after botulinum neurotoxin A interventions in children with spastic cerebral palsy.
- Authors
Schless, Simon‐Henri; Cenni, Francesco; Bar‐On, Lynn; Hanssen, Britta; Kalkman, Barbara; O'brien, Thomas; Aertbeliën, Erwin; Van Campenhout, Anja; Molenaers, Guy; Desloovere, Kaat; Schless, Simon-Henri; Bar-On, Lynn
- Abstract
<bold>Aim: </bold>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.<bold>Method: </bold>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.<bold>Results: </bold>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.<bold>Interpretation: </bold>Recurrent BoNT-A interventions may induce alterations to medial gastrocnemius volume and echo-intensity beyond the natural history of the spastic CP pathology.<bold>What This Paper Adds: </bold>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.
- Subjects
BOTULINUM toxin; CHILDREN with cerebral palsy; NATURAL history; MULTIPLE regression analysis; CEREBRAL palsy; ANTHROPOMETRY; COMPARATIVE studies; INTRAMUSCULAR injections; LEG; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MUSCLE relaxants; RESEARCH; RESEARCH funding; SPASTICITY; ULTRASONIC imaging; THREE-dimensional imaging; EVALUATION research; TREATMENT effectiveness; SKELETAL muscle; DISEASE complications
- Publication
Developmental Medicine & Child Neurology, 2019, Vol 61, Issue 7, p783
- ISSN
0012-1622
- Publication type
journal article
- DOI
10.1111/dmcn.14056