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Comparison of treatment effects between children with spastic cerebral palsy under and over five years after
Won-Yub Lee1, Gi-Young Park1, Dong Rak Kwon1
1Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
Insights
Younger children with spastic cerebral palsy (CP) showed greater improvements in ankle spasticity after botulinum toxin type A (BTA) injections compared to older children. Age is a key factor in BTA treatment planning for CP.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Spastic cerebral palsy (CP) is a common motor disorder in children.
- Ankle plantar flexor spasticity significantly impacts mobility and function in children with CP.
- Botulinum toxin type A (BTA) injections are a common treatment for focal spasticity.
Purpose of the Study:
- To investigate the influence of age on the efficacy of BTA injections for ankle plantar flexor spasticity in children with CP.
- To compare treatment outcomes between younger (<5 years) and older (≥5 years) children with spastic CP receiving BTA therapy.
Main Methods:
- A pilot study involving 16 children with spastic CP, divided into two age groups (<5 and ≥5 years).
- All participants received ultrasound-guided BTA injections into the gastrocnemius muscle.
- Evaluations included passive range of motion (PROM), Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM), and sonoelastography (RPI) at baseline and 1, 3, and 6 months post-injection.
Main Results:
- Both age groups showed significant improvements in PROM, MAS, and RPI post-BTA injection.
- Children under 5 years (group 1) demonstrated significantly greater improvements in PROM, MAS, and GMFM compared to the older group (group 2).
- Enhanced improvements in RPI were observed in the younger group at 3 and 6 months post-injection.
Conclusions:
- Age is a significant factor influencing the response to BTA injections for ankle spasticity in children with CP.
- Younger children (<5 years) may experience more substantial benefits from BTA treatment for spastic CP.
- Treatment plans involving BTA for pediatric spastic CP should consider patient age for optimized outcomes.
Objective:
To evaluate whether age influences a change in the spasticity of the ankle plantar flexor after botulinum toxin type A (BTA) injection in children with spastic cerebral palsy (CP).
Methods:
Sixteen children with spastic CP were enrolled in the study. Seven children (group 1) were under 5 years of age, and nine (group 2) were over 5 years of age. They all received BTA injection in the gastrocnemius muscle (GCM) under ultrasound guidance. Passive range of motion (PROM) of ankle dorsiflexion, Modified Ashworth Scale (MAS) of the ankle plantar flexor, Gross Motor Function Measure (GMFM) and median red pixel intensity (RPI) of the medial GCM on real-time sonoelastography were measured at baseline (pre-injection) and 1-, 3-, and 6-month post-injection.
Results:
In both groups, the mean PROM, MAS, and RPI were significantly improved after injection until 6-month post-injection. The change of PROM of ankle dorsiflexion in group 1 was significantly greater than that in group 2, until 6-month post-injection. The change in the MAS and GMFM between baseline and 6-month post-injection in group 1 was greater than that in group 2. The changes in the median RPI between baseline and 3- and 6-month post-injections were greater in group 1 than in group 2.
Conclusion:
Our pilot study demonstrated the different changes in spasticity of the ankle plantar flexor after BTA injection based on age. Therefore, age may be considered when establishing a treatment plan using BTA injection for children with spastic CP.
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