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Spread And Effectiveness Of Botulinum Neurotoxin A In Spastic Equinus In Cerebral Palsy

This study has been completed.
Information provided by:
Universita di Verona Identifier:
First received: January 10, 2011
Last updated: January 18, 2011
Last verified: November 2009

Objectives. To study the short-term neurophysiological and clinical outcome of botulinum toxin type A(BoNT-A), injected at standard doses, and assess toxin spread to neighboring uninjected muscles in children with cerebral palsy.

Subjects and methods. The investigators studied 18 ambulatory children with dynamic equinus foot deformity (mean age 6.1 years). The gastrocnemius muscle on the affected side was injected with BoNT-A (Dysport, range from 8.9-19.4 U/kg). As the primary neurophysiological outcome measure, compound muscle action potential (CMAP) areas were assessed in the lateral gastrocnemius (LG) and tibialis anterior(TA) muscles on the treated and untreated side before BoNT-A injections (T0), and on days 10 (T10), and 30 (T30) after injections. Clinical scales were assessed and video gait was analyzed at all three time points.

Results. In all patients, CMAP areas recorded from the LG and TA muscles on the treated side decreased significantly from pre-injection values at T10 (p<0.05) and T30 (p<0.002). Assessment at both time points after injections also showed that ankle spasticity had diminished (p<0.05), equinus foot excursion increased (p<0.05), and functional gait improved (p<0.05).

Conclusion. Although BoNT-A injected at standard doses improves gait in children with spastic equinus foot the toxin spreads to uninjected leg muscles. BoNT-A treatment for cerebral palsy therefore needs individualizing according to the child's clinical features.

Condition Intervention Phase
Cerebral Palsy and Botulinum Toxin Drug: Botulinum Toxin Type A Phase 4

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment

Resource links provided by NLM:

Further study details as provided by Universita di Verona:

Primary Outcome Measures:
  • BoNT-A injected into gastrocnemius within standard dose ranges spreads to surrounding anterior lower-limb muscles in children with CP and induces chemodenervation in injected muscles [ Time Frame: one month ]
    As the primary neurophysiological outcome measure of BoNT-A induced paresis and spread, we studied changes in compound muscle action potential (CMAP) areas recorded from the lateral gastrocnemius (LG) muscle after injecting BoNT-A and from the ipsilateral tibialis anterior (TA) muscle in children with spastic hemiplegia. In line with others we considered a decreased CMAP area from LG muscle injected with BoNT-A as the neurophysiological index of BoNT-A-induced paresis

Secondary Outcome Measures:
  • the short-term clinical effect of BoNT-A injected within standard dose ranges on changes in gait in children with CP [ Time Frame: 30 days ]
    As the clinical outcome measures clinical scales were assessed and video gait was analyzed before BoNT-A injections (T0), and on days 10 (T10), and 30 (T30) after injections.

Enrollment: 18
Study Start Date: December 2009
Study Completion Date: May 2010
Primary Completion Date: February 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: botulinum toxin A
botulinum toxin A diffusion in cerebral palsy
Drug: Botulinum Toxin Type A
BoNT-A (Dysport, Ipsen) ,into the medial gastrocnemius (MG) and LG muscles unilaterally on the affected spastic hemiplegic side; dose mean± SE, 283.3± 24.7 U.. The mean dose/kg injected was 14.4± 0.8, range from 8.5 to 20 U/kg, diluted in 2.5 ml saline. frequency: once.
Other Name: dysport, ipsen


Ages Eligible for Study:   25 Months to 9 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • spasticity refractory to oral medication
  • patients able to walk independently or with aid
  • no contraindications to BoNT-A treatment such as fixed contracture,aminoglycoside therapy and myasthenia gravis and no other neuromuscular diseases
  • no orthopedic surgery before
  • normal or mildly declined cognition
  • previous treatment at least six months before the study

Exclusion Criteria:

  • all contraindications to BoNT-A treatment
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Please refer to this study by its identifier: NCT01276015

Sponsors and Collaborators
Universita di Verona
Study Director: laura bertolasi, md Universita di Verona
  More Information

Responsible Party: manager en-chief dr Caffi Identifier: NCT01276015     History of Changes
Other Study ID Numbers: CE1780
Study First Received: January 10, 2011
Last Updated: January 18, 2011

Keywords provided by Universita di Verona:
BoNT-A-botulinum neurotoxin type A
CMAP-compound muscle action potential
CP-cerebral palsy
LG-lateral gastrocnemius
MG-medial gastrocnemius
TA-tibialis anterior
PROMS-passive range of movement
MAS-modified Ashworth scale
EVGS-Edinburgh visual gait scale
GMF-CS-gross motor function classification system

Additional relevant MeSH terms:
Cerebral Palsy
Brain Damage, Chronic
Brain Diseases
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Central Nervous System Diseases
Botulinum Toxins
Botulinum Toxins, Type A
Acetylcholine Release Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Cholinergic Agents
Neurotransmitter Agents
Physiological Effects of Drugs
Neuromuscular Agents
Peripheral Nervous System Agents processed this record on September 21, 2017