The Short-Term Impact of Botulinum Neurotoxin-A on Muscle Morphology and Gait in Children with Spastic Cerebral Palsy

Nicky Peeters, Eirini Papageorgiou, Britta Hanssen, Nathalie De Beukelaer, Lauraine Staut, Marc Degelaen, Christine Van den Broeck, Patrick Calders, Hilde Feys, Anja Van Campenhout, Kaat Desloovere

Research output: Contribution to journalArticlepeer-review

Abstract

Children with spastic cerebral palsy (SCP) are often treated with intramuscular Botulinum Neurotoxin type-A (BoNT-A). Recent studies demonstrated BoNT-A-induced muscle atrophy and variable effects on gait pathology. This group-matched controlled study in children with SCP compared changes in muscle morphology 8–10 weeks post-BoNT-A treatment (n = 25, median age 6.4 years, GMFCS level I/II/III (14/9/2)) to morphological changes of an untreated control group (n = 20, median age 7.6 years, GMFCS level I/II/III (14/5/1)). Additionally, the effects on gait and spasticity were assessed in all treated children and a subgroup (n = 14), respectively. BoNT-A treatment was applied following an established integrated approach. Gastrocnemius and semitendinosus volume and echogenicity intensity were assessed by 3D-freehand ultrasound, spasticity was quantified through electromyography during passive muscle stretches at different velocities. Ankle and knee kinematics were evaluated by 3D-gait analysis. Medial gastrocnemius (p = 0.018, −5.2%) and semitendinosus muscle volume (p = 0.030, −16.2%) reduced post-BoNT-A, but not in the untreated control group, while echogenicity intensity did not change. Spasticity reduced and ankle gait kinematics significantly improved, combined with limited effects on knee kinematics. This study demonstrated that BoNT-A reduces spasticity and partly improves pathological gait but reduces muscle volume 8–10 weeks post-injections. Close post-BoNT-A follow-up and well-considered treatment selection is advised before BoNT-A application in SCP.
Original languageEnglish
Article number676
Number of pages21
JournalToxins
Volume14
Issue number10
DOIs
Publication statusPublished - 29 Sep 2022

Bibliographical note

Funding Information:
This study was supported by the Flemish Organization for Scientific Research Foundation, Belgium (FWO-TBM/TAMTA-T005416N and FWO-G0B4619N) and Internal KU Leuven grant, Belgium, C24/18/103, Internal funding of KU Leuven Biomedical Sciences Group: Fund for Translational Biomedical Research, 2019. E.P. was supported by the Flemish Organization for Scientific Research Foundation, Belgium (grant number T003116N).

Publisher Copyright:
© 2022 by the authors.

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