Ann Rehabil Med.  2014 Apr;38(2):200-208.

Comparison of Treatment Effects Between Children With Spastic Cerebral Palsy Under and Over Five Years After Botulinum Toxin Type A Injection

• Lee WY
• Park GY
• Kwon DR

Abstract

OBJECTIVE
To evaluate whether age influences a change in the spasticity of the ankle plantar flexor after botulinum toxin type A (BTA) injection in children with spastic cerebral palsy (CP).
METHODS
Sixteen children with spastic CP were enrolled in the study. Seven children (group 1) were under 5 years of age, and nine (group 2) were over 5 years of age. They all received BTA injection in the gastrocnemius muscle (GCM) under ultrasound guidance. Passive range of motion (PROM) of ankle dorsiflexion, Modified Ashworth Scale (MAS) of the ankle plantar flexor, Gross Motor Function Measure (GMFM) and median red pixel intensity (RPI) of the medial GCM on real-time sonoelastography were measured at baseline (pre-injection) and 1-, 3-, and 6-month post-injection.
RESULTS
In both groups, the mean PROM, MAS, and RPI were significantly improved after injection until 6-month post-injection. The change of PROM of ankle dorsiflexion in group 1 was significantly greater than that in group 2, until 6-month post-injection. The change in the MAS and GMFM between baseline and 6-month post-injection in group 1 was greater than that in group 2. The changes in the median RPI between baseline and 3- and 6-month post-injections were greater in group 1 than in group 2.
CONCLUSION
Our pilot study demonstrated the different changes in spasticity of the ankle plantar flexor after BTA injection based on age. Therefore, age may be considered when establishing a treatment plan using BTA injection for children with spastic CP.

Keyword

Cerebral palsy; Age; Muscle spasticity; Botulinum toxin type A; Sonoelastography

MeSH Terms

Ankle
Botulinum Toxins, Type A*
Cerebral Palsy*
Child*
Elasticity Imaging Techniques
Humans
Muscle Spasticity
Muscle, Skeletal
Pilot Projects
Range of Motion, Articular
Ultrasonography
Botulinum Toxins, Type A

Figure

• 

  Fig. 1 Sequential changes in clinical and real-time sonoelastographic parameters at each month post-injection (MPI). In group 1 (under 5 years of age), there were significant differences in (A) passive range of motion of ankle dorsiflexion with knee extension (KE), (B) passive range of motion of ankle dorsiflexion with knee flexion (KF), (C) Modified Ashworth Scale (MAS), (D) Gross Motor Function Measure (GMFM), and (E) red pixel intensity (RPI) compared with those in group 2 (over 5 years of age). *p<0.05.

• 

  Fig. 2 Longitudinal real-time sonoelastography (RTS) image and color histogram of affected medial gastrocnemius muscle (GCM) in a 4-year-old boy. Yellow polygons and freehand selections depict regions of interest for quantitative analysis of the medial GCM on color histogram. (A) RTS image showed predominantly red color in medial GCM, and the median RPI of medial GCM was 169.7 at baseline. Follow-up RTS image showed purple to yellow color at post-treatment, and the median RPI was 130.9, 148.1, and 150.0 at 1 month (B), 3 months (C), and 6 months (D) post-treatment, respectively.

• 

  Fig. 3 Longitudinal real-time sonoelastography (RTS) image and color histogram of affected medial gastrocnemius muscle (GCM) in an 8-year-old boy. Yellow polygons and freehand selections depict regions of interest for quantitative analysis of the medial GCM on color histogram. (A) RTS image showed predominantly red color in medial GCM, and the median RPI of medial GCM was 172.1 at baseline. (B) RTS image showed purple to green color, and the median RPI was 146.2 at 1-month post-treatment. (C, D) RTS image showed green, yellow to red, and the median RPI was 158.0 and 162.4 at 3 and 6 months post-treatment, respectively.

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