Hip lateralisation in children with bilateral spastic cerebral palsy treated with botulinum toxin type A: a 2-year follow-up

• Published in: Neuropediatrics Vol. 42; no. 1; p. 18
• Main Authors: Jung, N H, Heinen, F, Westhoff, B, Doederlein, L, Reissig, A, Berweck, S, Linder-Lucht, M, Schandelmaier, S, Mall, V
• Format: Journal Article
• Language: English
• Published: Germany 01.02.2011
• Subjects: Botulinum Toxins, Type A - therapeutic use; Cerebral Palsy - diagnostic imaging; Cerebral Palsy - drug therapy; Cerebral Palsy - pathology; Child; Child, Preschool; Female; Functional Laterality - drug effects; Functional Laterality - physiology; Hip - physiopathology; Humans; Injections, Intramuscular - methods; Longitudinal Studies; Male; Neuromuscular Agents - therapeutic use; Pain Measurement; Statistics, Nonparametric; Time Factors; Tomography, X-Ray Computed - methods
• DOI: 10.1055/s-0031-1275344

We investigated the effect of BoNT/A injection on hip lateralisation in children with bilateral spastic cerebral palsy and bilateral adductor spasticity. Pelvic radiographs using Reimers' migration index (MI) were evaluated from 27 children (n=9 females, n=18 males; mean age 5.2 ± 1.96 years; range: 2-10 years; initial MI <50%) with bilateral spastic cerebral palsy over a time period of 2 years. All received injections of BoNT/A (Dysport) every 12 weeks with a dose of 30 Units per kilogram body weight into adductor and medial hamstring muscles on both sides. The MI was calculated before treatment and after 1 and 2 years. The mean MI increased from 25.5% (range: 0-48) to 26.7% (+1.2%, range: 0-79) on the right side and from 28.0% (range: 0-40) to 30.6% (+2.6%, range: 3-84) on the left side over 2 years, respectively. Hips of one patient dislocated bilaterally. The mean MI remained stable over 2 years. Although a specific BoNT/A effect cannot be proven because of the open design of this study, we provide strong evidence that the MI can be kept stable for a time period of 2 years under non-surgical management including therapy with BoNT/A even in CP patients with a high risk for hip dislocation.