Yonsei Med J.  2008 Aug;49(4):545-552. 10.3349/ymj.2008.49.4.545.

Is Electrical Stimulation Beneficial for Improving the Paralytic Effect of Botulinum Toxin Type A in Children with Spastic Diplegic Cerebral Palsy?

• Rha DW
• Yang EJ
• Chung HI
• Kim HB
• Park CI
• Park ES

• KMID: 1793189
• DOI: http://doi.org/10.3349/ymj.2008.49.4.545

Abstract

PURPOSE
The purpose of the present study was to investigate whether electrical stimulation (ES) improves the paralytic effect of botulinum toxin type A (BTX-A) and evaluate the differences between low frequency (LF) and high frequency (HF) ES in children with spastic diplegic cerebral palsy (CP). MATERIALS and METHODS: Twenty-three children with spastic diplegia CP who had BTX-A injections into both gastrocnemius muscles were assessed. Following the toxin injection, electrical stimulation was given to 1 side of the injected muscles and a sham-stimulation to the other side for 30 min a day for 7 consecutive days [HFES (25Hz) to 11 children, LFES (4Hz) to 12 children]. The compound motor action potentials (CMAP) from the gastrocnemius muscle were assessed before injection and at 5 time points (days 3, 7, 14, 21, and 30) after injection. The clinical assessments of spasticity were performed before and 30 days after injection. RESULTS: The CMAP area became significantly lower in both LFES and HFES sides from 3 days after injection compared to baseline values. In other words, the CMAP area of the sham-stimulated side showed a significant decrease at 7 or 14 days after injection. However, there were no significant differences in clinical assessment of spasticity between the stimulated and sham-stimulated sides. CONCLUSION: Short-term ES in both LF and HF to the spastic muscles injected with BTX-A might induce earlier denervating action of BTX-A. However, it does not necessarily lead to clinical and electrophysiological benefits in terms of reduction of spasticity.

Keyword

Botulinum toxin type A; electrical stimulation; cerebral palsy; spasticity

MeSH Terms

Botulinum Toxin Type A/*therapeutic use
Cerebral Palsy/*drug therapy/*physiopathology
Child, Preschool
Electric Stimulation
Electrophysiology
Female
Humans
Male
Paralysis/*drug therapy/*physiopathology

Figure

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  Fig. 1 Comparison of amplitude and area of compound motor action potential between the 4 Hz frequency stimulated side and sham-stimulated side of gastrocnemius muscles in children with spastic CP (n = 12). *p < 0.05, before injection vs. each time point after injection.

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  Fig. 2 Comparison of amplitude and area of compound motor action potential between the 25 Hz frequency stimulated side and sham-stimulated side of gastrocnemius muscles in children with spastic CP (n = 11). *p < 0.05, before injection vs. each time point after injection.

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