School of Sport Science, Exercise & Health, The University of Western Australia, Perth, WA, Australia.
Dev Med Child Neurol. 2013 Sep;55(9):813-20. doi: 10.1111/dmcn.12200. Epub 2013 Jun 22.
With evidence for an atrophic effect of botulinum toxin type A (BoNT-A) documented in typically developing muscles, this study investigated the immediate morphological alterations of muscles in children with cerebral palsy (CP) after BoNT-A treatment.
Fifteen children (10 males, five females; age range 5-11y, mean age 8y 5mo, SD 1y 10mo) with spastic diplegic CP [Gross Motor Function Classification System Levels I (n=9) and II (n=6)] receiving BoNT-A injections for spasticity management were included. None of the children was a first-time receiver of BoNT-A. Magnetic resonance imaging and Mimics software assessed muscle volume, timed 2 weeks before and 5 weeks after injection. All participants received BoNT-A bilaterally to the gastrocnemius muscle, and five participants also received BoNT-A bilaterally to the medial hamstring muscles. Functional assessment measures used were the 6-Minute Walk Test (6-MWT), the Timed Up and Go (TUG) test, and hand-held dynamometry.
Whilst total muscle group volume of the injected muscle group remained unchanged, a 4.47% decrease in the injected gastrocnemius muscle volume (p=0.01) and a 3.96% increase in soleus muscle volume (p=0.02) was evident following BoNT-A. There were no statistically significant changes in function after BoNT-A as assessed by the TUG. There was also no statistically significant change in distance covered in the 6-MWT. Muscle strength, as assessed using hand-held dynamometry was also not statistically different after BoNT-A treatment.
Muscle volume decreases were observed in the injected muscle (gastrocnemius), with synergistic muscle hypertrophy that appeared to compensate for this decrement. The 4% to 5% decrease in the volume of BoNT-A injected muscles are not dramatic in comparison to reports in recent animal studies, and are a positive indication for BoNT-A, particularly as it also did not negatively alter function.
已有证据表明，A型肉毒毒素（BoNT-A）可导致正常发育的肌肉萎缩，本研究旨在观察 BoNT-A 治疗脑瘫（CP）患儿后的即刻肌肉形态变化。
本研究纳入了 15 名痉挛性双瘫 CP 患儿（10 名男性，5 名女性；年龄 5-11 岁，平均年龄 8 岁 5 个月，标准差 1 岁 10 个月），这些患儿均接受 BoNT-A 注射以治疗痉挛。所有患儿均不是首次接受 BoNT-A 治疗。磁共振成像和 Mimics 软件评估了肌肉体积，在注射前 2 周和注射后 5 周进行测量。所有患儿均接受双侧比目鱼肌 BoNT-A 注射，5 名患儿还接受双侧内侧腘绳肌 BoNT-A 注射。使用 6 分钟步行测试（6-MWT）、计时起立-行走测试（TUG）和手持测力计评估功能评估测量值。
尽管注射肌肉组的总肌肉群体积保持不变，但注射的比目鱼肌体积减少了 4.47%（p=0.01），而比目鱼肌体积增加了 3.96%（p=0.02）。BoNT-A 后，TUG 评估的功能没有统计学上的显著变化。6-MWT 中覆盖的距离也没有统计学上的显著变化。使用手持测力计评估的肌肉力量在 BoNT-A 治疗后也没有统计学上的差异。
注射的肌肉（比目鱼肌）体积减小，协同肌肉出现代偿性肥大，似乎弥补了这种减少。与最近的动物研究报告相比，BoNT-A 注射肌肉体积减少 4%至 5%并不显著，这是 BoNT-A 的一个积极迹象，特别是因为它也没有对功能产生负面影响。
