Hip Lateralisation in Children with Bilateral Spastic Cerebral Palsy Treated with Botulinum Toxin Type A: A 2-Year Follow-Up

Abstract

We investigated the effect of BoNT/A injection on hip lateralisation in children with bilateral spastic cerebral palsy and bilateral adductor spasticity. Pelvic radiographs using Reimers' migration index (MI) were evaluated from 27 children (n=9 females, n=18 males; mean age 5.2 ± 1.96 years; range: 2-10 years; initial MI <50%) with bilateral spastic cerebral palsy over a time period of 2 years. All received injections of BoNT/A (Dysport) every 12 weeks with a dose of 30 Units per kilogram body weight into adductor and medial hamstring muscles on both sides. The MI was calculated before treatment and after 1 and 2 years. The mean MI increased from 25.5% (range: 0-48) to 26.7% (+1.2%, range: 0-79) on the right side and from 28.0% (range: 0-40) to 30.6% (+2.6%, range: 3-84) on the left side over 2 years, respectively. Hips of one patient dislocated bilaterally. The mean MI remained stable over 2 years. Although a specific BoNT/A effect cannot be proven because of the open design of this study, we provide strong evidence that the MI can be kept stable for a time period of 2 years under non-surgical management including therapy with BoNT/A even in CP patients with a high risk for hip dislocation.

Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results

“…Pain reduction was impressive, and hip stability was excellent, even after 16.7 years [17]. Soft-tissue procedures and other conservative treatment can influence progression of femoral-head migration but cannot stop it [7,8]. If the MP is >60 % or a defect of the acetabular rim is present-which in most cases is laterally, superiorly and posteriorly directedbony reconstruction of the hip should be performed to reestablish good coverage and joint shape [12,31].…”

“…In early stages of dislocation, physiotherapy and soft-tissue lengthening of the adductor and iliopsoas muscles can be effective in improving the situation at the hip joint. Conservative treatment can influence the progression of femoral-head migration but cannot stop it [7,8]. In some cases displacement of the hip continues and further measures need to be undertaken.…”

The Effect of Obturator Nerve Block on Hip Lateralization in Low Functioning Children with Spastic Cerebral Palsy

“…However, a single ON block did not result in a significant difference in hip displacement between the groups for the long term. MPs can be kept stable for over 2 years with BoNT-A injections every 12 weeks, even in CP patients with a high risk for hip dislocation 17. In our study, the effect of the ON block lasted over 6 months in both clinical and hip lateralization.…”

“…Recently, botulinum toxin type-A (BoNT-A) injection into hip adductor muscles has been tested for alleviating progressive hip displacement and has shown some beneficial effects in alleviating hip lateralization along with reducing hip adductor spasticity 6,17,18. In addition, children with low gross motor function, as determined by the gross motor function classification system (GMFCS; levels III to V), have poorer results in alleviating progressive hip dislocation after BoNT-A injection compared to children with high function at GMFCS levels I and II 6.…”

The Concept of «Key Muscles» and the Early Onset of Botulinum Therapy in Spastic Forms of Cerebral Palsy

“…Риск вывиха бедра пропорционален степени тяже-сти двигательных нарушений и наиболее выражен у нехо-дячих детей с двусторонними формами ДЦП, как минимум 1/3 которых рано или поздно потребуют хирургического вмешательства на тазобедренных суставах [66]. Раннее применение ботулинотерапии способствует профилакти-ке вывиха в тазобедренном суставе при ДЦП или отсроч-ке хирургического вмешательства [65,67,68]. Вместе с тем остается спорным вопрос о возможности и степени влияния ботулинотерапии на улучшение индекса мигра-ции головки бедра.…”