title: Hip lateralisation in children with bilateral spastic cerebral palsy treated with botulinum toxin type A: a 2-year follow-up.
abstract: 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.
authors.affiliation: Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany.
authors.forename: N H
authors.initials: NH
authors.lastname: Jung
authors.forename: F
authors.initials: F
authors.lastname: Heinen
authors.forename: B
authors.initials: B
authors.lastname: Westhoff
authors.forename: L
authors.initials: L
authors.lastname: Doederlein
authors.forename: A
authors.initials: A
authors.lastname: Reissig
authors.forename: S
authors.initials: S
authors.lastname: Berweck
authors.forename: M
authors.initials: M
authors.lastname: Linder-Lucht
authors.forename: S
authors.initials: S
authors.lastname: Schandelmaier
authors.forename: V
authors.initials: V
authors.lastname: Mall
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D007839:Functional Laterality / Q000187:drug effects / Q000502:physiology*; D006615:Hip / Q000503:physiopathology*; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010147:Pain Measurement; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A