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

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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.

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References

  1. Berker N, Yalçın S (2005) The HELP guide to cerebral palsy. Global-Help Publication, Istanbul, Turkey, pp 1–144

    Google Scholar 

  2. Özel S (2011) Serebral palsi. In: Beyazova M, Kutsal YG (eds) Fiziksel Tıp ve Rehabilitasyon Güneş Tıp Kitapevleri. 2nd edn. Ankara, Turkey, pp 2681–2724

  3. Serdaroğlu A, Cansu A, Ozkan S, Tezcan S (2006) Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol 48:413–416

    Article  PubMed  Google Scholar 

  4. Heinen F, Molenaers G, Fairhurst C, Carr LJ, Desloovere K, Chaleat Valayer E, Morel E, Papavassiliou AS, Tedroff K, Ignacio Pascual-Pascual S, Bernert G, Berweck S, Di Rosa G, Kolanowski E, Krägeloh-Mann I (2006) European consensus table 2006 on botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 10:215–25

    Article  PubMed  Google Scholar 

  5. Lannin N, Scheinberg A, Clark K (2006) AACPDM systematic review of the effectiveness of therapy for children with cerebral palsy after botulinum toxin A injections. Dev Med Child Neurol 48:533–539

    Article  PubMed  Google Scholar 

  6. Tilton AH (2015) Evidence-based review of safety and efficacy in cerebral palsy. Toxicon 107(Pt A):105–8. https://doi.org/10.1016/j.toxicon.2015.09.020

    Article  PubMed  CAS  Google Scholar 

  7. Willenborg MJ, Shilt JS, Smith BP, Estrada RL, Castle JA, Koman LA (2002) Technique for iliopsoas ultrasound-guided active electromyography-directed botulinum a toxin injection in cerebral palsy. J Pediatr Orthop 22:165–168. https://doi.org/10.1097/01241398-200203000-00005

    Article  PubMed  Google Scholar 

  8. Kaymak B, Kara M, Tok F, Ulaşli A, Öztürk GT, Chang KV, Hsiao MY, Hung CY, On AY, Özçakar L (2017) Sonographic guide for botulinum toxin injections of the lower limb: euro-musculus/USPRM spasticity approach. Eur J Phys Rehabil Med. https://doi.org/10.23736/S1973-9087.17.04667-6

    Article  PubMed  Google Scholar 

  9. Bohannon RW, Smith MB (1987) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67:206–207

    Article  PubMed  CAS  Google Scholar 

  10. Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, Raina PS, Galuppi BE (2000) Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 80:974–985

    PubMed  CAS  Google Scholar 

  11. Koman LA, Mooney JF, Smith B, Goodman A, Mulvaney T (1993) Management of cerebral palsy with botulinum-A toxin: preliminary investigation. J Pediatr Orthop 13:489–495

    Article  PubMed  CAS  Google Scholar 

  12. Hägglund G, Wagner P (2008) Development of spasticity with age in a total population of children with cerebral palsy. BMC Musculoskelet Disord 6:9. https://doi.org/10.1186/1471-2474-9-150

    Article  Google Scholar 

  13. Chounti A, Hägglund G, Wagner P, Westbom L (2013) Sex differences in cerebral palsy incidence and functional ability: a total population study. Acta Paediatr 102:712–717. https://doi.org/10.1111/apa.12240

    Article  PubMed  CAS  Google Scholar 

  14. Westbom L, Hägglund G, Nordmark E (2007) Cerebral palsy in a total population of 4–11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems. BMC Pediatr 7:41

    Article  PubMed  PubMed Central  Google Scholar 

  15. Degerstedt F, Wiklund M, Enberg B (2016) Physiotherapeutic interventions and physical activity for children in northern Sweden with cerebral palsy: a register study from equity and gender perspectives. Glob Health Action 10:2. https://doi.org/10.1080/16549716.2017.1272236

    Article  Google Scholar 

  16. Franzén M, Hägglund G, Alriksson-Schmidt A (2017) Treatment with Botulinum toxin A in a total population of children with cerebral palsy—a retrospective cohort registry study. BMC Musculoskelet Disord 18:520. https://doi.org/10.1186/s12891-017-1880

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kedem P, Scher D (2015) Foot deformities in children with cerebral palsy. Curr Opin Pediatr 27:67–74

    Article  PubMed  Google Scholar 

  18. Nordmark E, Hägglund G, Lauge-Pedersen H, Wagner P, Westbom L (2009) Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study. BMC Med 28:65. https://doi.org/10.1186/1741-7015-7-65

    Article  Google Scholar 

  19. Baker R, Jasinski M, Maciag-Tymecka I, Michalowska-Mrozek J, Bonikowski M, Carr L, MacLean J, Lin JP, Lynch B, Theologis T, Wendorff J, Eunson P, Cosgrove A (2002) Botulinum toxin treatment of spasticity in diplegic cerebral palsy A randomized, double-blind, placebo-controlled, dose-ranging study. Dev Med Child Neurol 44:666–675

    Article  PubMed  CAS  Google Scholar 

  20. Py AG, Zein Addeen G, Perrier Y, Carlier RY, Picard A (2009) Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance. Ann Phys Rehabil Med 52:215–223

    Article  PubMed  Google Scholar 

  21. Bradley M, O’Donnell P (2002) Atlas of musculoskeletal ultrasound anatomy. Cambridge University Press, Cambridge

    Google Scholar 

  22. Kaymak B, Kara M, Yağiz-On A, Soylu AR, Özçakar L (2017) Innervation zone targeted botulinum toxin injections. Eur J Phys Rehabil Med. https://doi.org/10.23736/S1973-9087.17.04663-9

    Article  PubMed  Google Scholar 

  23. Buyukavci R, Akturk S, Ersoy Y (2018) Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients; an observational study. Eur J Phys Rehabil Med. https://doi.org/10.23736/S1973-9087.18.05086-4

    Article  PubMed  Google Scholar 

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkey

    Raikan Büyükavcı

  2. Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Faculty of Medicine, Inonu University, Malatya, Turkey

    Mehmet Akif Büyükavcı

Authors
  1. Raikan Büyükavcı
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  2. Mehmet Akif Büyükavcı
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Correspondence to Raikan Büyükavcı.

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Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Ethical approval was not taken because of the retrospective design of the study. This study was conducted according to 1964 Helsinki declaration principles.

Informed consent

This study has retrospective design. A written informed consent was obtained from relatives of each patient for BoNT-A application.

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Büyükavcı, R., Büyükavcı, M.A. Effects of ultrasound-guided botulinum toxin type-A injections with a specific approach in spastic cerebral palsy. Acta Neurol Belg 118, 429–433 (2018). https://doi.org/10.1007/s13760-018-0929-5

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  • DOI: https://doi.org/10.1007/s13760-018-0929-5

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