Effectiveness of Botulinum Toxin A First Injection on Gastrocnemius Muscle Spasticity in Children with Cerebral Palsy: Clinical and Elastosonography Study
Background: An accurate assessment of the spasticity in the spastic forms of cerebral palsy (CP) is important to establish the effectiveness of therapeutic management. The modified Ashworth scale (MAS) is the most frequently used method in the assessment of spasticity in clinical practice. However, this method does not allow an objective, precise and reliable assessment because of the lack of standardization and the low level of reliability. Elastosonography (ES) is an imaging method that assesses the viscoelastic characteristics of tissues non-invasively. Aim: The aim of this study was to assess the stiffness of gastrocnemius muscle (GCM) in children with spastic CP by ES and to investigate the sonoelastographic changes and its correlations with clinical evaluation parameters (MAS) after botulinum toxin type A (BTA) injections. Methods: This prospective, analytical and diagnostic study involved children with spastic CP receiving a first injection of BTA to GCM. Muscle stiffness was measured with MAS and ES before the procedure, and at 1, 2, 3, 4 weeks, 3 and 6 months post-injection. ES parameter [Strain Index Value (SIV)] and MAS scores before and after the treatment were compared. Results: Fifteen children with spastic CP were enrolled in the study. The mean age was 6.8 years ± 3.85 and the mean body weight was 21.4 kg ± 7.8. Abobotulinum toxin A (Dysport®) injections were administered to 5 children (33.3%) with an average dose of 180 ± 179.44 units and Onabotulinum toxin A (Botox®) injections were administered to 10 children (66.7%) with an average dose of 63 ± 27.51 units in GCM. The average MAS score was 2.5 and SIV was measured as 2.38 ± 0.57 before BTA. At 2 weeks after BTA injection, significant improvements were observed in MAS grades and SIV (p < 0.05). These statistically significant improvements persisted for up to 3 months for the MA score and only 2 months for the SIV. Positive significant correlations were observed between the SIV and the MAS score at different times of the evaluation. Conclusion: The results of this study suggest that ES is a promising diagnostic tool allowing the assessment of the viscoelasticity of spastic muscles in real time as it was described in the spasticity stretch reflex.
Cite this paper
Boudokhane, S. , Kalai, A. , Migaou, H. , Borgi, O. , Hmida, B. , Jellad, A. and Frih, Z. B. S. (2023). Effectiveness of Botulinum Toxin A First Injection on Gastrocnemius Muscle Spasticity in Children with Cerebral Palsy: Clinical and Elastosonography Study. Open Access Library Journal, 10, e517. doi: http://dx.doi.org/10.4236/oalib.1110517.
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