title: Comparative assessment of therapeutic response to physiotherapy with or without botulinum toxin injection using diffusion tensor tractography and clinical scores in term diplegic cerebral palsy children.
abstract: The present study was to compare the effects of combined therapy [botulinum (BTX) plus physiotherapy] with physiotherapy alone using diffusion tensor imaging (DTI) derived fractional anisotropy (FA) values of motor and sensory fiber bundles and clinical grade of the disability to see the value of BTX in term children with spastic diplegic cerebral palsy (CP). Clinically diagnosed 36 children participated in the study. All these children were born at term, and had no history of seizures. The study was randomly categorized into two groups: group I (n=18) - physiotherapy alone and group II (n=18) - physiotherapy plus BTX injection. Quantitative diffusion tensor tractography on all these children was performed on motor and sensory fiber bundles on baseline as well as after 6months of therapy. Motor function and clinical grades were also measured by gross motor function measures (GMFM) scale on both occasions. We observed significant change in FA value in motor and sensory fiber bundle as well as in GMFM scores at 6months compared to baseline study in both the groups. However, delta change and relative delta change in FA values of sensory and motor fiber bundle as well as GMFM score between group I and group II was statistically insignificant. We conclude that addition of BTX to physiotherapy regimen does not influence the outcome at 6months with similar insult in children with term diplegic spastic CP. This information may influence management of diplegic CP especially in developing countries, where BTX is beyond the reach of these children.
authors.affiliation: Magnetic Resonance Section, Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Saurabh K
authors.initials: SK
authors.lastname: Chaturvedi
authors.forename: Yogita
authors.initials: Y
authors.lastname: Rai
authors.forename: Ankita
authors.initials: A
authors.lastname: Chourasia
authors.forename: Puneet
authors.initials: P
authors.lastname: Goel
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Paliwal
authors.forename: Ravindra K
authors.initials: RK
authors.lastname: Garg
authors.forename: Ram Kishore S
authors.initials: RK
authors.lastname: Rathore
authors.forename: Chandra M
authors.initials: CM
authors.lastname: Pandey
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Gupta
mesh_terms: D001905:Botulinum Toxins / Q000008:administration & dosage*; D001921:Brain / Q000187:drug effects / Q000473:pathology; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000473:pathology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D026741:Physical Therapy Modalities; D011597:Psychomotor Performance / Q000187:drug effects
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins