Effect of Botulinum Toxin Injection on the Progression of Hip Dislocation in Patients with Spastic Cerebral Palsy: A Pilot Study

Lee, Yookyung; Lee, Seung‐Eun; Jang, Joonyoung; Lim, Jiwoon; Ryu, Ju Seok

doi:10.3390/toxins13120872

Cited by 9 publications

(17 citation statements)

References 30 publications

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“…The emphasis on adductor spasticity and contracture has led to an emphasis on abduction bracing, spasticity reduction by injections of Botulinum Neurotoxin A (BoNT-A) and APR surgery [ 45 , 46 , 47 ]. The outcomes of these interventions, in comparison to bony reconstructive surgery which addresses the abnormal proximal femoral geometry, are unpredictable and often disappointing [ 48 ].…”

Section: The Cause Of Hip Displacement In Children With Cerebral Pals...mentioning

confidence: 99%

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Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Howard

Willoughby

Thomason

et al. 2023

JCM

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Hip displacement is the second most common musculoskeletal deformity in children with cerebral palsy. Hip surveillance programs have been implemented in many countries to detect hip displacement early when it is usually asymptomatic. The aim of hip surveillance is to monitor hip development to offer management options to slow or reverse hip displacement, and to provide the best opportunity for good hip health at skeletal maturity. The long-term goal is to avoid the sequelae of late hip dislocation which may include pain, fixed deformity, loss of function and impaired quality of life. The focus of this review is on areas of disagreement, areas where evidence is lacking, ethical dilemmas and areas for future research. There is already broad agreement on how to conduct hip surveillance, using a combination of standardised physical examination measures and radiographic examination of the hips. The frequency is dictated by the risk of hip displacement according to the child’s ambulatory status. Management of both early and late hip displacement is more controversial and the evidence base in key areas is relatively weak. In this review, we summarise the recent literature on hip surveillance and highlight the management dilemmas and controversies. Better understanding of the causes of hip displacement may lead to interventions which target the pathophysiology of hip displacement and the pathological anatomy of the hip in children with cerebral palsy. We have identified the need for more effective and integrated management from early childhood to skeletal maturity. Areas for future research are highlighted and a range of ethical and management dilemmas are discussed.

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Section: The Cause Of Hip Displacement In Children With Cerebral Pals...mentioning

confidence: 99%

“…Injection of botulinum toxin A (BoNT-A) to the hip adductors, hip flexors and hamstrings has been practiced for many years for the reduction of focal spasticity in children with CP [ 46 , 47 ]. However, the evidence that repeated injections of BoNT-A can prevent or even slow HD is mixed.…”

Section: Injections Of Botulinum Neurotoxin a Combined With Bracingmentioning

confidence: 99%

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Howard

Willoughby

Thomason

et al. 2023

JCM

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“…Owing to this laxity, the MI changed every time plain radiographs were acquired and even improved after botulinum toxin injection. 16 , 32 Therefore, hip braces can be used as a promising treatment method.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, several studies regarding nonsurgical treatment for hip displacement, including various types of hip abduction braces, postural alignment seating systems, and botulinum toxin injection, have reported inconsistent results. 15 , 16 , 17 , 18 , 19 , 20 In previous research, we showed that a seating system with medial knee support could act as a fulcrum, thereby accelerating progressive hip displacement in patients with nonambulatory spastic cerebral palsy. 21 In a follow-up study, the electromyographic activity of adductor muscles was significantly decreased after introducing a dynamic hip compression bandage, suggesting potential benefits.…”

Section: Introductionmentioning

confidence: 98%

Efficacy of a Hip Brace for Hip Displacement in Children With Cerebral Palsy

et al. 2022

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ImportanceThere is no consensus on interventions to slow the progress of hip displacement in patients with cerebral palsy.ObjectiveTo investigate the efficacy of a novel hip brace in preventing progressive hip displacement in patients with cerebral palsy.Design, Setting, and ParticipantsThis 2-group randomized clinical trial was conducted at 4 tertiary hospitals in South Korea from July 2019 to November 2021. Participants included children aged 1 to 10 years with nonambulatory cerebral palsy (Gross Motor Function Classification System level IV or V). Block randomization was used to assign an equal number of patients to the study and control groups via computerized random allocation sequences. Data were analyzed from November to December 2021.InterventionsThe intervention group wore the hip brace for at least 12 hours a day for the study duration (ie, 12 months). Follow-up evaluations were performed after 6 and 12 months of wearing the brace. Both groups proceeded with conventional rehabilitation therapy during the trial.Main Outcomes and MeasuresThe primary outcome was the Reimers migration index (MI) on radiography, as assessed by 3 blinded investigators. Primary outcome variables were analyzed using linear mixed models. Secondary outcomes include change in the Caregiver Priorities &amp; Child Health Index of Life with Disabilities, on which lower scores indicate better quality of life.ResultsA total of 66 patients were included, with 33 patients (mean [SD] age, 68.7 [31.6] months; 25 [75.8%] boys) randomized to the intervention group and 33 patients (mean [SD] age, 60.7 [24.9] months; 20 [60.6%] boys) randomized to the control group. The baseline mean (SD) MI was 37.4% (19.3%) in the intervention group and 30.6% (16.3%) in the control group. The mean difference of the MI between the intervention group and control group was −8.7 (95% CI, −10.2 to −7.1) percentage points at 6 months and −12.7 (95% CI, −14.7 to −10.7) percentage points at 12 months. The changes in the Caregiver Priorities &amp; Child Health Index of Life with Disabilities were favorable in the study group and reached statistical significance at the 6-month follow-up compared with the control group (difference, −14.2; 95% CI, −25.2 to −3.3).Conclusions and RelevanceIn this randomized clinical trial, the novel hip brace was significantly effective in preventing the progression of hip displacement, compared with the control group. It effectively improved quality of life in patients with nonambulatory cerebral palsy. Therefore, hip brace use could be a promising treatment method to delay hip surgery and improve the quality of life of patients with nonambulatory cerebral palsy.Trial RegistrationClinicalTrials.gov Identifier: NCT04033289

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“…Despite the association of BTX and hip dysplasia being classic and widely recommended in the literature [ 28 , 29 , 34 ], high-quality evidence of the prevention of hip displacement is lacking. From a physiopathologic mechanism perspective, BTX treatment is recommended [ 27 ] in patients with initial subluxation or with strong spasticity and concomitant risk factors of dislocation before radiologic evidence of subluxation [ 16 , 17 ]; the high odds ratio confirms this trend.…”

Section: Discussionmentioning

confidence: 99%

Prediction Model for Identifying Computational Phenotypes of Children with Cerebral Palsy Needing Neurotoxin Treatments

Bertoncelli

Latalski

Bertoncelli

et al. 2022

Toxins

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Factors associated with neurotoxin treatments in children with cerebral palsy (CP) are poorly studied. We developed and externally validated a prediction model to identify the prognostic phenotype of children with CP who require neurotoxin injections. We conducted a longitudinal, international, multicenter, double-blind descriptive study of 165 children with CP (mean age 16.5 ± 1.2 years, range 12–18 years) with and without neurotoxin treatments. We collected functional and clinical data from 2005 to 2020, entered them into the BTX-PredictMed machine-learning model, and followed the guidelines, “Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis”. In the univariate analysis, neuromuscular scoliosis (p = 0.0014), equines foot (p < 0.001) and type of etiology (prenatal > peri/postnatal causes, p = 0.05) were linked with neurotoxin treatments. In the multivariate analysis, upper limbs (p < 0.001) and trunk muscle tone disorders (p = 0.02), the presence of spasticity (p = 0.01), dystonia (p = 0.004), and hip dysplasia (p = 0.005) were strongly associated with neurotoxin injections; and the average accuracy, sensitivity, and specificity was 75%. These results have helped us identify, with good accuracy, the clinical features of prognostic phenotypes of subjects likely to require neurotoxin injections.

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Effect of Botulinum Toxin Injection on the Progression of Hip Dislocation in Patients with Spastic Cerebral Palsy: A Pilot Study

Cited by 9 publications

References 30 publications

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Hip Surveillance and Management of Hip Displacement in Children with Cerebral Palsy: Clinical and Ethical Dilemmas

Efficacy of a Hip Brace for Hip Displacement in Children With Cerebral Palsy

Prediction Model for Identifying Computational Phenotypes of Children with Cerebral Palsy Needing Neurotoxin Treatments

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