Botulinum toxin injection for Cockayne syndrome with muscle spasticity over bilateral lower limbs: A case report

Abstract

BACKGROUND Cockayne syndrome (CS) is a rare inherited disease characterized by progressive motor symptoms including muscle weakness, joint contracture, ataxia, and spasticity. Botulinum neurotoxin type A has been used for conditions such as dystonia and spasticity, but it has rarely been used in patients with CS. CASE SUMMARY We report a 6-year-and-9-mo old girl diagnosed with CS who received an injection of botulinum neurotoxin type A to manage her difficulty with walking. A total dose of 210 units of botulinum neurotoxin type A was administered into the bilateral tibialis posterior and gastrocnemius muscles. To evaluate the treatment effects on spasticity, joint contracture, pain, and ataxia, measurement tools including the Modified Ashworth Scale, the passive range of motion, the Faces Pain Scale-Revised, and the Scale for the Assessment and Rating of Ataxia, were employed. The first week after the injection, the Modified Ashworth Scale score for the plantar flexors and foot invertors improved bilaterally, along with advancements in the passive range of motion of the bilateral ankles and a lower score for the Faces Pain Scale-Revised. These treatment effects persisted to the 8 th week post-injection, but returned to baseline values at the 12 th week post-injection, except for the pain scale. CONCLUSION Botulinum toxin injection can thus be considered as a treatment option for lower extremity spasticity, joint contracture, and pain derived from CS.

Botulinum Toxin Type A: Efficacy and Safety Profile in the Treatment of Lower Limb Spasticity in Children with genetic Disorders

“…Burlina et al, 2004), HSS/PKAN(Lin et al, 2018;Neves et al, 2008), MLD(Borges et al, 2020;Singh et al, 2009), Pelizaeus-Merzbacher disease (PMD)(Brender et al, 2015), SLS(Anil G, 2019;Cho et al, 2018;Hidalgo et al, 2017), Alexander disease(Machol et al, 2018), Aicardi-Goutières syndrome (AGS)(Videira et al, 2020), Cockayne syndrome(Hsu et al, 2021)and in combination with epidural analgesia in one child with MSUD(Kaki & Arab, 2012…”