Botulinum neurotoxin type A responders among children with spastic cerebral palsy: Pattern-specific effects

• Published in: European journal of paediatric neurology Vol. 49; pp. 131 - 140
• Main Authors: Papageorgiou, E., Peeters, N., Staut, L., Molenaers, G., Ortibus, E., Van Campenhout, A., Desloovere, K.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2024
• Subjects: Adolescent; Biomechanical Phenomena - drug effects; Botulinum neurotoxin type A; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - pharmacology; Botulinum Toxins, Type A - therapeutic use; Cerebral Palsy - complications; Cerebral Palsy - drug therapy; Cerebral Palsy - physiopathology; Child; Child, Preschool; Children; Female; Gait - drug effects; Gait - physiology; Gait Disorders, Neurologic - drug therapy; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - physiopathology; Gait patterns; Humans; Male; Muscle Spasticity - drug therapy; Muscle Spasticity - etiology; Muscle Spasticity - physiopathology; Muscle, Skeletal - drug effects; Muscle, Skeletal - physiopathology; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - pharmacology; Responders; Retrospective Studies; Spastic cerebral palsy; Treatment; Treatment Outcome; Botulinum neurotoxin type A; Gait patterns; Treatment; Spastic cerebral palsy; Children; BoNT; GMFCS; CP; Responders
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2024.02.017

To identify short-term effects of botulinum neurotoxin type A (BoNT) injections on gait and clinical impairments, in children with spastic cerebral palsy (CP), based on baseline gait pattern-specific subgroups. Short-term effects of BoNT injections in the medial hamstrings and gastrocnemius were defined in a retrospective convenience sample of 117 children with CP (median age: 6 years 4 months; GMFCS I/II/III: 70/31/16; unilateral/bilateral: 56/61) who had received gait analyses before and 2 months post-BoNT. First, baseline gait patterns were classified. Statistical and meaningful changes were calculated between pre- and post-BoNT lower limb sagittal plane kinematic waveforms, the gait profile score, and non-dimensional spatiotemporal parameters for the entire sample and for pattern-specific subgroups. These gait waveforms per CP subgroup at pre- and post-BoNT were also compared to typically developing gait and composite scores for spasticity, weakness, and selectivity were compared between the two conditions. Kinematic improvements post-BoNT were identified at the ankle and knee for the entire sample, and for subgroups with apparent equinus and jump gait. Limbs with baseline patterns of dropfoot and to a lesser extent true equinus showed clear improvements only at the ankle. In apparent equinus, jump gait, and dropfoot, spasticity improved post-BoNT, without leading to increased weakness or diminished selectivity. Compared to typical gait, knee and hip motion improved in the crouch gait subgroup post-BoNT. This comprehensive analysis highlighted the importance of investigating BoNT effects on gait and clinical impairments according to baseline gait patterns. These findings may help identify good treatment responders. [Display omitted] •Baseline gait patterns can help identify good BoNT-responders.•Comprehensive analyses to reveal pattern-specific BoNT-effects.•Two-level improvements (ankle and knee) found for apparent equinus and jump gait.•Ankle improvements for dropfoot and true equinus subgroups.•Spasticity improvements for apparent equinus, jump gait and dropfoot.