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Development of spasticity with age in a total population of children with cerebral palsy
Gunnar Hägglund1, Philippe Wagner
1Department of Orthopaedics, Lund University Hospital, S-221 85 Lund, Sweden. gunnar.hagglund@med.lu.se
Insights
In children with cerebral palsy (CP), spasticity in the gastrocnemius-soleus muscle increases until age 4, then decreases by age 12. This pattern holds across spastic CP subtypes, impacting clinical care and research.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Spasticity development with age in children with cerebral palsy (CP) has not been previously studied.
- A Swedish CP register and healthcare program initiated in 1994 provided longitudinal muscle tone data.
- Muscle tone is measured using the modified Ashworth scale biannually until age six, then annually.
Purpose of the Study:
- To analyze the age-related development of spasticity in children with CP.
- To understand the trajectory of muscle tone changes from birth to adolescence in CP.
- To identify patterns of spasticity progression and regression over time.
Main Methods:
- Analysis of 6218 muscle tone measurements (modified Ashworth scale) in 547 children with CP (0-15 years) from 1995-2006.
- CP subtypes classified using the Surveillance of Cerebral Palsy in Europe network system.
- Piecewise logistic regression used to evaluate age-related patterns after dichotomizing the Ashworth scale (0-1 vs. 2-4).
Main Results:
- Overall muscle tone increased up to age 4, then decreased annually until age 12.
- Approximately 47% of children had Grade 2-4 spasticity at age 4, decreasing to 23% by age 12.
- Spastic bilateral and unilateral CP subtypes followed the general pattern; dyskinetic CP showed increased tone until age 6, then decreased.
Conclusions:
- Childhood spasticity, measured by the Ashworth scale, peaks around age 4 and declines by age 12 in children with CP.
- This developmental trajectory is consistent across spastic CP subtypes.
- Findings inform clinical management and future research on spasticity interventions in CP.
Background:
The development of spasticity with age in children with cerebral palsy (CP) has, to our knowledge, not been studied before. In 1994, a register and a health care program for children with CP in southern Sweden were initiated. In the programme the child's muscle tone according to the modified Ashworth scale is measured twice a year until six years of age, then once a year. We have used this data to analyse the development of spasticity with age in a total population of children with cerebral palsy.
Methods:
All measurements of muscle tone in the gastrocnemius-soleus muscle in all children with CP from 0 to 15 years during the period 1995-2006 were analysed. The CP subtypes were classified according to the Surveillance of Cerebral Palsy in Europe network system. Using these criteria, the study was based on 6218 examinations in 547 children. For the statistical analysis the Ashworth scale was dichotomized. The levels 0-1 were gathered in one category and levels 2-4 in the other. The pattern of development with age was evaluated using piecewise logistic regression in combination with Akaike's An Information Criterion.
Results:
In the total sample the degree of muscle tone increased up to 4 years of age. After 4 years of age the muscle tone decreased each year up to 12 years of age. A similar development was seen when excluding the children operated with selective dorsal rhizotomy, intrathecal baclofen pump or tendo Achilles lengthening. At 4 years of age about 47% of the children had spasticity in their gastro-soleus muscle graded as Ashworth 2-4. After 12 years of age 23% of the children had that level of spasticity. The CP subtypes spastic bilateral and spastic unilateral CP showed the same pattern as the total sample. Children with dyskinetic type of CP showed an increasing muscle tone up to age 6, followed by a decreasing pattern up to age 15.
Conclusion:
In children with CP, the muscle tone as measured with the Ashworth scale increases up to 4 years of age and then decreases up to 12 years of age. The same tendency is seen in all spastic subtypes. The findings may have implications both for clinical judgement and for research studies on spasticity treatment.
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