Effects of ultrasound-guided botulinum toxin type-A injections with a specific approach in spastic cerebral palsy

Abstract

The aim of this study was to detect effects of ultrasound-guided botulinum toxin type-A (US-guided BoNT-A) injections prepared according to lower extremity innervation zones on spasticity and motor function in 3-16 years children with diplegic and hemiplegic spastic cerebral palsy. This study included 25 patients between 3 and 16 years of age who admitted to our clinic in 2017, were being followed in our clinic with a diagnosis of cerebral palsy, had BoNT-A injections due to lower extremity spasticity. The US-guided BoNT-A injections were administered into the spastic muscles using a specific approach according to innervation zones of muscle. Modified Ashworth Scale (MAS) and Gross Motor Functional Classification System (GMFCS) were assessed at the baseline, and 4 and 12 weeks after the BoNT-A injections. Minimum and maximum ages of the patients were 45 and 192 months, and gender distribution was 8 females and 17 males. Significant decreases in the MAS scores of the knee and ankle tones were measured 4 and 12 weeks after the BoNT-A injection when compared to the baseline scores (p < 0.025). Hip muscle tonus only decreased 12 weeks after the injection (p < 0.025). In parallel with a reduction in spasticity GMFCS improved from 3 to 2 in the 4th and 12th weeks. US-guided BoNT-A injections with Euro-musculus approach is a practical and effective method to perform injections into proper points of proper muscles in children with spastic cerebral palsy.

A consensus statement on the use of botulinum toxin in pediatric patients

“…111,[139][140][141][142][143][144][145][146][147] Table 1 demonstrates many of the most commonly injected muscles. Two studies have demonstrated efficacy in using this approach for BoNT injections in both the CP population and adult stroke 148,149 ; however, there are no studies that compare this method to other techniques.…”

Effect of Botulinum Toxin- A injection for the Lower Limb in Children with Spastic Cerebral Palsy

“…BoNT-A can be injected into the spastic muscle by palpation, electromyography (EMG), electrostimulation (ES), or under ultrasound (US) guidance [13]. Under US and EMG guidance, the injections are 90-99% effective even in small muscles [14]. However, because the injection in EMGguided infusion is painful, it is usually performed under general anesthesia for adults and children.…”

Personalized approach to the treatment of supporting motor disturbances of the lower extremities in children with spastic forms of cerebral palsy

“…Despite the nonprogressive course of the disease, children with CP require continuous dynamic observation, conservative treatment, and timely orthopedic treatment because of their neurological symptoms and concomitant secondary disorders of the musculoskeletal system (e. g., joint contracture, joint dislocation, bone torsion, and changes in the ligamentous apparatus) in the ontogenesis of motor development [5,6]. The following main groups of therapeutic effects have been distinguished by the European Consensus for the treatment of CP: oral antispastic pharmacotherapy, orthopedic surgery, botulinum therapy, intrathecal baclofen, orthotics, and functional therapy (including physiotherapy) [7]. Orthopedic surgery is necessary for the treatment of secondary joint contracture and skeletal deformities in patients with CP [8].…”