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The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy: a 12-month prospective study

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

This study was a 12-month prospective investigation of changes in the medial gastrocnemius (MG) muscle morphology in children aged 2–5 years with spastic cerebral palsy (CP) who had received no previous intramuscular injections of botulinum neurotoxin type-A (BoNT-A) and were randomised to receive either single or multiple (three) BoNT-A injections to the gastrocsoleus. MG morphological changes were compared to age-matched typically developing (TD) peers.

Methods

Thirteen children with spastic CP with a mean age of 45 (15) months and 18 TD children with a mean age of 48 (14) months participated in the study. The principal outcome measures were MG muscle volume, fascicle length, pennation angle and physiological cross-sectional area (PCSA), which were obtained using 2D and 3D ultrasound.

Results

The single and multiple injection frequency groups significantly increased MG muscle volume at 12 months relative to the baseline by 13 and 15 %, respectively. There were no significant differences in the MG muscle volume 28.5 (12.3) versus 30.3 (3.8) ml, fascicle length 48.0 (10.4) versus 44.8 (1.2) mm or PCSA 7.0 (1.2) versus 6.6 (1.7) cm2 between the single and multiple injection groups, respectively, at 12 months follow-up. The change in MG muscle volume in the single and multiple injection groups was significantly lower than the TD peers by 66 and 60 %, respectively.

Interpretation

In young children with spastic CP, naive to BoNT-A treatment, MG muscle growth over 12 months does not appear to be influenced by intramuscular BoNT-A injection frequency. However, MG muscle growth in the spastic CP groups was significantly lower than the age-matched TD peers. It is unclear whether this is an effect of intramuscular BoNT-A injections or reduced growth rates in children with spastic CP in general. Controlled investigations and longitudinal studies with multiple measurement time points are required in order to determine the influence of BoNT-A treatment on muscle physiological and mechanical growth factors in young children with spastic CP.

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Acknowledgments

The authors thank the staff of the Hugh Williamson Gait Analysis Laboratory, The Royal Children’s Hospital, Melbourne, for their assistance with this study. This work was supported by funding from the National Health and Medical Research Council, Australia (Biomedical Postgraduate Scholarship Grant ID: 481953).

Conflict of interest

Professor H. Kerr Graham wishes to disclose a conflict of interest in respect of: (1) unrestricted research grants from Allergan, (2) consultant to Merz.

Author information

Authors and Affiliations

  1. Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Herston, QLD, 4029, Australia

    Lee Barber

  2. Hugh Williamson Gait Laboratory, The Royal Children’s Hospital, Melbourne, VIC, 3052, Australia

    Tandy Hastings-Ison & H. Kerr Graham

  3. Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne, VIC, 3052, Australia

    Tandy Hastings-Ison & H. Kerr Graham

  4. Centre for Health, Sport and Rehabilitation Sciences Research, School of Health Sciences, University of Salford, Manchester, M5 4WT, UK

    Richard Baker

  5. The University of Melbourne, Melbourne, VIC, 3010, Australia

    H. Kerr Graham

  6. Centre for Musculoskeletal Research, Griffith Health Institute and School of Rehabilitation Sciences, Griffith University, Southport, QLD, 4222, Australia

    Rod Barrett

  7. The School of Human Movement Studies, The University of Queensland, St Lucia, QLD, 4072, Australia

    Glen Lichtwark

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  1. Lee Barber
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  2. Tandy Hastings-Ison
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Corresponding author

Correspondence to Lee Barber.

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Barber, L., Hastings-Ison, T., Baker, R. et al. The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy: a 12-month prospective study. J Child Orthop 7, 425–433 (2013). https://doi.org/10.1007/s11832-013-0503-x

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  • DOI: https://doi.org/10.1007/s11832-013-0503-x

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