Botulinum Toxin a Injection Combined with Radial Extracorporeal Shock Wave Therapy in Children with Spastic Cerebral Palsy: Shear Wave Sonoelastographic Findings in the Medial Gastrocnemius Muscle, Preliminary Study.

Dong Rak Kwon,Dae Gil Kwon

doi:10.3390/children8111059

Dong Rak Kwon, Dae Gil Kwon

Open Access

https://doi.org/10.3390/children8111059

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Journal: Children (Basel, Switzerland)	Publication Date: Nov 17, 2021
Citations: 9	License type: CC BY 4.0

Affiliation: Catholic University of Daegu

Abstract

Therapeutic strategies to boost the effect of botulinum toxin may lead to some advantages, such as long lasting effects, the injection of lower botulinum toxin dosages, fewer side effects, and lower costs. The aim of this study is to investigate the combined effect of botulinum toxin A (BTA) injection and extracorporeal shock wave therapy (ESWT) for the treatment of spasticity in children with spastic cerebral palsy (CP). Fifteen patients with spastic CP were recruited through a retrospective chart review to clarify what treatment they received. All patients received a BTA injection on gastrocnemius muscle (GCM), and patients in group 1 underwent one ESWT session for the GCM immediately after BTA injection and two consecutive ESWT sessions at weekly intervals. Ankle plantar flexor and the passive range of motion (PROM) of ankle dorsiflexion were measured by a modified Ashworth scale (MAS) before treatment and at 1 and 3 month(s) post-treatment. In group 1, the shear wave velocity (SWV) of GCM was measured. The PROM and MAS in group 1 and 2 before treatment significantly improved at 1 and 3 month(s) after treatment. The change in PROM was significantly different between the two groups at 1 and 3 month(s) after treatment. The SWV before treatment significantly decreased at 1 month and 3 months after treatment in group 1. Our study has shown that the combination of BTA injection and ESWT would be effective at controlling spasticity in children with spastic CP, with sustained improvement at 3 months after treatment.

Highlights

Cerebral palsy (CP), mostly caused by brain damage before, during, or after birth, is characterised by abnormal development of posture and movement
Our study has shown that the combination of botulinum toxin A (BTA) injection and extracorporeal shock wave therapy (ESWT) would be effective at controlling spasticity in children with spastic CP, with sustained improvement at 3 months after treatment
Taking into account the importance of synergistic, effective, and long-lasting spasticity treatment as well as the issues described above, we aimed to explore the combined effect of BTA injection and ESWT to control spasticity in patients with spastic CP using shearwave sonoelastography (SWS)

Summary

Introduction

Cerebral palsy (CP), mostly caused by brain damage before, during, or after birth, is characterised by abnormal development of posture and movement. Spasticity in children with CP may result in various disabilities, including joint contractures, decreased muscle strength, and a reduced ability to perform activities of daily living. A wide range of therapeutic strategies has been applied to manage spasticity, including physical modalities, oral medication, peripheral neuromuscular blockade, intrathecal agents, and surgical procedures [1]. Botulinum toxin A (BTA) injection has been suggested as a powerful and safe treatment method for focal spasticity in both the upper and lower limbs of children with CP [2,3,4,5]. The relaxation of spastic muscles resulting from BTA injection improves the function of upper and lower limbs as well as gait, and prevents fixed contractures [6,7]. BTA works by inhibiting acetylcholine release from nerve endings in spastic muscles [8]

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