Yonsei Med J.  2014 Sep;55(5):1406-1412. 10.3349/ymj.2014.55.5.1406.

Architectural Changes of the Gastrocnemius Muscle after Botulinum Toxin Type A Injection in Children with Cerebral Palsy

• Park ES
• Sim E
• Rha DW
• Jung S

• KMID: 1799510
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1406

Abstract

PURPOSE
This study used ultrasonography (US) to investigate the architectural changes in gastrocnemius muscles (GCM) after botulinum toxin injection (BoNT-A) in children with cerebral palsy (CP).
MATERIALS AND METHODS
Thirteen children with CP who received a BoNT-A injection into their GCM to treat equinus were recruited (9 males and 4 females). Architectural changes in both the medial and lateral heads of the GCM from a total of 20 legs were assessed using B-mode, real-time US. Muscle thickness (MT), fascicle length (FL), and fascicle angle (FA) were measured over the middle of the muscle belly in both a resting and neutral ankle position. Measures at 1 and 3 months after the injection were compared with baseline data taken before the injection.
RESULTS
The mean age of the subjects was 5.8 (+/-1.6) years. Spasticity was significantly reduced when measured by both the modified Tardieu scale and the modified Ashworth scale at 1 and 3 months after injection (p<0.05). The MT and FA of both the medial and lateral heads of the GCM were significantly reduced for both neutral and resting ankle positions at 1 and 3 months after the injection. The FL of both the medial and lateral heads of the GCM were significantly increased in a resting position (p<0.05), but not in a neutral position.
CONCLUSION
Our results demonstrated muscle architectural changes induced by BoNT-A injection. The functional significances of these changes were discussed.

Keyword

Botulinum toxin type A; ultrasonic imaging; cerebral palsy

MeSH Terms

Acetylcholine Release Inhibitors/*adverse effects/therapeutic use
Botulinum Toxins/*adverse effects/therapeutic use
Cerebral Palsy/*drug therapy
Child
Child, Preschool
Female
Humans
Male
Muscle, Skeletal/anatomy & histology/*drug effects/ultrasonography
Acetylcholine Release Inhibitors
Botulinum Toxins

Figure

• 

  Fig. 1 Ultrasonographic measurements of muscle thickness (A), fascicle length (B), and fascicle angle (C). (A) Muscle thickness: the longest distance between fascia of gastrocnemius muscle in cross sectional ultrasound image. (B) Fascicle length: the length of muscle fiber between fascia in longitudinal ultrasound image. (C) Fascicle angle: the angle between muscle fiber and estimated parallel fascia line in longitudinal ultrasound image.

• 

  Fig. 2 Changes of spasticity after botulinum toxin type A injection. (A) Changes of modified Ashworth scale after botulinum toxin type A injection. (B) Changes of modified Tardieu scale after botulinum toxin type A injection. *Before injection-injection after 1 month are significantly different. †Before injection-injection after 3 months are significantly different: p value <0.05 in Wilcoxon signed rank test. R1, the point in the ROM where a catch was felt during a quick stretch of the ankle plantarflexor; R2, total passive ROM of ankle dorsiflexion.

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