Abstract
Botulinum toxin type A (BoNT-A) injections in children with cerebral palsy (CP) may negatively affect muscle growth and strength. We injected BoNT-A into the affected limbs of 14 children (4.57 ± 2.28 years) with hemiplegic CP and exhibiting tip-toeing gait on the affected side and investigated the morphological alterations in the medial head of the gastrocnemius muscle (GCM). We assessed thickness of the GCM, fascicle length, and fascicle angle on the affected and unaffected sides at baseline at 4 and 12 weeks after BoNT-A injections. The primary outcome measure was the change (percentage) in GCM thickness in the affected side treated with BoNT-A in comparison with the unaffected side. The percentage of treated GCM thickness became significantly thinner at 4 and 12 weeks after BoNT-A injection than baseline. However, the percentage of fascicle length and angle in treated limbs showed no significant change from baseline 4 and 12 weeks after the injection. BoNT-A injections might reduce muscle thickness in children with spastic hemiplegic CP. Fascicle length and angle might not be affected by BoNT-A injections after correction of normal growth of the children.
Highlights
In spastic cerebral palsy (CP), muscle strength is usually compromised, resulting in a decrease in functional capacity [1,2]
Key Contribution: We investigated morphological alterations in the medial head of the gastrocnemius muscle in spastic hemiplegic cerebral palsy after injecting botulinum toxin type A into the affected limb
We investigated the morphological alterations in the gastrocnemius muscle (GCM) after Botulinum toxin type A (BoNT-A) injection in children with spastic hemiplegic CP by comparing the affected limbs treated with BoNT-A and the unaffected limb
Summary
In spastic cerebral palsy (CP), muscle strength is usually compromised, resulting in a decrease in functional capacity [1,2]. Botulinum toxin type A (BoNT-A) is often injected into the affected muscles to reduce spasticity and improve gait function in children with CP [2,3,4,5,6]. BoNT-A injections in children with CP may negatively affect muscle growth and strength. CP revealed that muscle volume is 22% smaller than that in typically developing peers between the ages of 2 and 5 years [5] and 37% smaller than that in unaffected young adults [4]. It is reported that the thickness and cross-sectional area of the GCM in ambulatory children with spastic CP did not differ from those in typically developing peers when the lower leg Toxins 2019, 11, 688; doi:10.3390/toxins11120688 www.mdpi.com/journal/toxins
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