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Quantifying Effect of Onabotulinum Toxin A on Passive Muscle Stiffness in Children with Cerebral Palsy Using

Joline E Brandenburg1, Sarah F Eby, Pengfei Song

  • 1From the Department of Physical Medicine and Rehabilitation (JEB), Department of Neurology (JEB), Department of Pediatric and Adolescent Medicine (JEB), Mayo Graduate School, Medical Scientist Training Program, Mayo Clinic College of Medicine (SFE), Department of Radiology (PS), Department of Health Sciences Research (WRB), Department of Physiology and Biomedical Engineering (GCS, K-NA), and Division of Orthopedic Research (K-NA), Mayo Clinic, Rochester, Minnesota.

American Journal of Physical Medicine & Rehabilitation
|February 7, 2018
PubMed

Insights

Onabotulinum toxin A (BoNT-A) temporarily improved passive muscle properties in children with cerebral palsy, as measured by shear wave elastography. These effects on muscle stiffness resolved by three months post-injection.

Area of Science:

  • Biomedical Engineering
  • Pediatric Neurology
  • Rehabilitation Medicine

Background:

  • Cerebral palsy (CP) often leads to muscle spasticity and altered passive muscle properties.
  • Onabotulinum toxin A (BoNT-A) is used to manage spasticity in children with CP.
  • Quantifying the direct effects of BoNT-A on muscle tissue properties is crucial for understanding treatment efficacy.

Purpose of the Study:

  • To longitudinally assess the impact of onabotulinum toxin A (BoNT-A) on passive muscle properties in children with cerebral palsy.
  • To utilize ultrasound shear wave elastography (SWE) as a tool to measure changes in muscle stiffness.
  • To correlate changes in muscle properties with clinical outcomes.

Main Methods:

  • A prospective longitudinal cohort study design was employed.
  • Ultrasound shear wave elastography (SWE) was used to measure the shear modulus of the lateral gastrocnemius muscle.
  • Measurements were taken before and at 1 and 3 months after BoNT-A injections in pediatric patients with CP.

Main Results:

  • A significant reduction in the shear modulus (indicating decreased stiffness) of the lateral gastrocnemius was observed at 1 month post-BoNT-A at 10-degrees and 0-degrees plantar flexion (P = 0.02 and P = 0.03, respectively).
  • No significant differences in passive range of motion or spasticity scores were detected between pre-injection and post-injection time points.
  • The observed changes in shear modulus were not significantly different from baseline values by 3 months post-BoNT-A, suggesting a temporary effect.

Conclusions:

  • Ultrasound shear wave elastography can detect changes in passive muscle properties following BoNT-A treatment in children with cerebral palsy.
  • The observed improvements in muscle stiffness are transient, resolving by 3 months post-injection.
  • While BoNT-A may alter muscle mechanical properties, its impact on passive range of motion and spasticity in this cohort was not significant within the study period.
Abstract

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