Changes in Muscle Mass after Botulinum Toxin Injection in Children with Spastic Hemiplegic Cerebral Palsy.

Dongwoo Lee,Mi-Hyang Han,Dae-Hyun Jang,Ja-Young Oh,Da-Ye Kim,Ji-Hye Kang,Jaewon Kim

doi:10.3390/toxins13040278

Dongwoo Lee, Mi-Hyang Han + Show 5 more

Open Access

https://doi.org/10.3390/toxins13040278

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Journal: Toxins	Publication Date: Apr 14, 2021
Citations: 5	License type: CC BY 4.0

Affiliation: Incheon St. Mary's Hospital, Catholic University of Korea

Abstract

We aimed to evaluate muscle mass changes after injection of botulinum toxin (BoNT) in children with spastic hemiplegic cerebral palsy (CP). Children aged between 2 and 12 years who were diagnosed with hemiplegic CP with spastic equinus foot were prospectively recruited and administered BoNT in the affected leg. Lean body mass (LBM) of both legs and total limbs was measured by dual-energy X-ray absorptiometry (DXA) preinjection and 4 and 12 weeks after injection. A total of 15 children were enrolled into the study. LBM of both legs and total limbs increased significantly over 12 weeks of growth. The ratio of LBM of the affected leg to total limbs and to the unaffected leg significantly reduced at 4 weeks after injection compared with preinjection but significantly increased at 12 weeks after injection compared with 4 weeks after injection. In conclusion, the muscle mass of the affected leg after BoNT injection in children with hemiplegic spastic CP decreased at 4 weeks after BoNT injection but significantly recovered after 12 weeks after injection.

Highlights

Cerebral palsy (CP) is a nonprogressive neurodevelopmental disorder that can cause physical disability, such as delayed motor development, gait disturbance, or activity limitation [1,2]
These findings suggest that Botulinum toxin (BoNT) injection can cause muscle atrophy and paralysis in the targeted muscles and the adjacent muscles
It is reported that synergistic muscle hypertrophy occurs after BoNT injection, which is caused by compensatory mechanisms to adapt muscle weakness [16,17]

Summary

Introduction

Cerebral palsy (CP) is a nonprogressive neurodevelopmental disorder that can cause physical disability, such as delayed motor development, gait disturbance, or activity limitation [1,2]. Botulinum toxin (BoNT) type A injections are widely used to manage spasticity, pain, and functional outcomes in CP and have proved to be effective in improving change in equinus foot and gait parameters [7]. It is generally considered safe, there is a concern that BoNT injection may negatively affect muscle mass and strength [7,8,9,10]. We measured the change in entire LBM of the affected leg, unaffected leg, and total limbs using DXA preinjection as well as at 4 and 12 weeks after injection in children with spastic hemiplegic CP

Study Participants

Ratio of LBM

Conclusions