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Botulinum toxin type A for spasticity in cerebral palsy patients: Which impact on popliteal angle to hamstring
Massimiliano Murgia1, Alessandro de Sire2, Pierangela Ruiu1
1Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy.
Insights
Incobotulinum toxin A injections effectively reduced hamstring spasticity in children with cerebral palsy (CP), improving gait and knee extension. This treatment demonstrated safety and efficacy for managing spasticity in CP patients.
Area of Science:
- Neurology
- Pediatric Rehabilitation
- Pharmacology
Background:
- Cerebral palsy (CP) is a common childhood physical disability characterized by motor impairments like spasticity, weakness, and stiffness.
- These impairments negatively impact functional activities, particularly gait development in children.
- Hamstring spasticity is a significant contributor to abnormal gait patterns in CP.
Purpose of the Study:
- To evaluate the effect of ultrasound-guided Incobotulinum toxin A injections on hamstring spasticity.
- To investigate the changes in popliteal angle and hamstring length post-injection.
- To assess the impact on functional mobility and knee extension in CP patients.
Main Methods:
- A proof-of-concept study involving pediatric outpatients with CP and hamstring spasticity causing crouch gait.
- Measurements included Modified Ashworth Scale (MAS), Popliteal Angle, Passive Knee Extension, and 10 Meter Walk Test (10MWT).
- Assessments were conducted at baseline (T0) and three weeks post-ultrasound-guided Incobotulinum Toxin A injection (T1).
Main Results:
- Thirteen patients (mean age 9.91 years) with CP and hamstring spasticity were included.
- Significant improvements were observed post-injection: MAS decreased (2.4 to 1.7, p<0.01), popliteal angle improved (from -51.7° to 41.3°, p<0.001), and passive knee extension increased (-14.0° to -4.0°, p<0.05).
- The 10MWT also showed improvement (14.3 to 12.6 seconds, p<0.05), with no reported adverse events.
Conclusions:
- Incobotulinum toxin A is a safe and effective treatment for hamstring spasticity in pediatric CP patients.
- The treatment led to significant improvements in spasticity, popliteal angle, passive knee extension, and walking test results.
- Further research with larger cohorts and longer follow-up is recommended to confirm efficacy on the popliteal angle.
Background:
Cerebral palsy (CP) is the most common physical disability in childhood. It is a heterogeneous condition in terms of etiology, motor type and severity of impairments. Clinical impairments, such as increased muscle tone (spasticity), muscle weakness and joint stiffness contribute to the abnormal development of functional activities, including gait.
Objective:
The objective of this study was to investigate the popliteal angle to hamstring length after ultrasound guided Incobotulinum toxin A injections for spasticity in CP patients.
Methods:
In this proof-of-concept study, we included outpatients with CP and crouch gait correlated to hamstrings spasticity referred to the Pediatric Rehabilitation outpatient clinic of Umberto I University Hospital, Sapienza University of Rome, in the period between February and October 2018.
Methods:
Modified Ashworth Scale (MAS) of hamstring muscles, Popliteal Angle and Modified Popliteal Angle, Passive Knee Extension and 10 Meter Walk Test (10MWT) were assessed at baseline (T0) and three weeks after ultrasound guided injection (T1) of Incobotulinum Toxin A (dose weight and site dependent).
Results:
Thirteen patients (5 male and 8 female), mean aged 9.91 ± 3.59, were included. The clinical evaluation at T0 showed hamstring muscles spasticity, with MAS of 2.4 ± 0.6, popliteal angle -51.7∘± 11.0∘, modified popliteal angle of -39.5∘± 11.0∘, passive knee extension of -14.0∘± 8.7∘ and 10MWT of 14.3 ± 4.6 seconds. At T1, hamstring muscles MAS mean value was 1.7 ± 0.6 (p< 0.01), popliteal angle 41.3∘± 7.0∘ (p< 0.001), modified popliteal angle -32.9∘± 10.4∘ (p< 0.001), passive knee extension -4.0∘± 4.2∘ (p< 0.05) and 10MWT 12.6 ± 4.8 seconds (p< 0.05). None of the treated patients reported any adverse event related to Incobotulinum Toxin A injection.
Conclusion:
Incobotulinum toxin A treatment has been proven to be safe and effective for hamstring muscles spasticity management in CP patients. Further studies with larger samples and longer follow-up are warranted to assess the efficacy of this treatment on the popliteal angle.
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