Chemodenervation is a standard of care for treating spasticity in children.
There is a question of whether repeat injections can cause muscle atrophy, because atrophy has been noted in rabbits who get repeat injections of botox. This phenomenon has not been observed in children.
There is a question of whether repeat injections can cause muscle atrophy, because atrophy has been noted in rabbits who get repeat injections of botox. This phenomenon has not been observed in children.
Weakness is increasingly noted in CP now that we can better control spasticity.
Let me just quote the summary of this article:
"It is currently recommended that spasticity should be treated before children with spastic CP reach the age of 5 or 6 years, so that muscle spasticity and the progression of muscle contracture is reduced [52].
The standard of care for spasticity management involves a combination of modalities, including physiotherapy, orthotics, oral pharmacological agents and neuromuscular blocking agents such as BoNT-A"
The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy: a 12-month prospective studyJournal of Children's Orthopaedics
This study was a 12-month prospective investigation of changes in the medial gastrocnemius (MG) muscle morphology in children aged 2–5 years with spastic cerebral palsy (CP) who had received no previous intramuscular injections of botulinum neurotoxin type-A (BoNT-A) and were randomised to receive either single or multiple (three) BoNT-A injections to the gastrocsoleus. MG morphological changes were compared to age-matched typically developing (TD) peers.
Methods
Thirteen children with spastic CP with a mean age of 45 (15) months and 18 TD children with a mean age of 48 (14) months participated in the study. The principal outcome measures were MG muscle volume, fascicle length, pennation angle and physiological cross-sectional area (PCSA), which were obtained using 2D and 3D ultrasound.
Results
The single and multiple injection frequency groups significantly increased MG muscle volume at 12 months relative to the baseline by 13 and 15 %, respectively. There were no significant differences in the MG muscle volume 28.5 (12.3) versus 30.3 (3.8) ml, fascicle length 48.0 (10.4) versus 44.8 (1.2) mm or PCSA 7.0 (1.2) versus 6.6 (1.7) cm2 between the single and multiple injection groups, respectively, at 12 months follow-up. The change in MG muscle volume in the single and multiple injection groups was significantly lower than the TD peers by 66 and 60 %, respectively.
Interpretation
In young children with spastic CP, naive to BoNT-A treatment, MG muscle growth over 12 months does not appear to be influenced by intramuscular BoNT-A injection frequency. However, MG muscle growth in the spastic CP groups was significantly lower than the age-matched TD peers.
pediatric rehabilitation houston, botox for children
pediatric rehabilitation houston, botox for children
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