“Does BoNT-A Alter Ultrasonographic Muscle Morphology in Children with Cerebral Palsy?”
AACPDM 80th Annual Meeting, Pennsylvania, Amerika Birleşik Devletleri, 27 - 30 Eylül 2026, (Yayınlanmadı)
- Yayın Türü: Bildiri / Yayınlanmadı
- Basıldığı Şehir: Pennsylvania
- Basıldığı Ülke: Amerika Birleşik Devletleri
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Kocaeli Üniversitesi Adresli: Evet
Özet
Does BoNT-A Alter Ultrasonographic Muscle Morphology in Children with Cerebral Palsy?
Nigar Dursun¹, Mustafa Kadıoğlu¹, Törehan Özer²
¹ Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
² Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
Introduction and Objective
Botulinum neurotoxin type A (BoNT-A) is widely used to reduce spasticity and support motor function in children with cerebral palsy (CP). However, the long-term effects of repeated BoNT-A injections on muscle structure, including their association with muscle atrophy and fibrotic changes, remain unclear. Ultrasonography enables noninvasive, real-time assessment of morphological characteristics such as muscle cross-sectional area, thickness, and echogenicity. Nevertheless, studies examining the effects of repeated BoNT-A injections on muscle dimensions and values normalized to anthropometric measurements in children with CP are limited. This study aimed to investigate the relationship between repeated BoNT-A injections and the morphological characteristics of the medial gastrocnemius muscle in children with CP.
Methods
This comparative cross-sectional study included 26 children aged 4–18 years with spastic CP, classified at Gross Motor Function Classification System (GMFCS) levels I–III. Children who had received at least three BoNT-A treatment sessions and participated in a neurological rehabilitation program constituted the BoNT-A group (n=13). Children who had never received BoNT-A and participated in a regular rehabilitation program constituted the control group (n=13). The clinically most affected lower limb of each participant was assessed. In addition to demographic and anthropometric measurements, clinical assessments included the Gross Motor Function Measure-66 (GMFM-66), Observational Gait Scale (OGS), and Modified Ashworth Scale (MAS). Medial gastrocnemius cross-sectional area and muscle thickness were measured using ultrasonography, and muscle echogenicity was graded using the Modified Heckmatt Scale (MHS). Cross-sectional area was normalized to body surface area and body weight, while muscle thickness was normalized to height and fibular length. Continuous variables were compared using the Mann–Whitney U test, and categorical variables were compared using Pearson’s chi-square test or Fisher’s exact test. Statistical significance was set at p<0.05.
Results
No statistically significant differences were found between the BoNT-A and control groups in medial gastrocnemius cross-sectional area (p=0.369), cross-sectional area normalized to body surface area (p=0.893), or cross-sectional area normalized to body weight (p=0.185). Similarly, there were no significant between-group differences in muscle thickness (p=0.570), muscle thickness normalized to height (p=0.562), or muscle thickness normalized to fibular length (p=0.602). MHS scores were also comparable between groups (p=0.086).
Discussion and Conclusion
In this study, repeated BoNT-A injections combined with neurological rehabilitation were not associated with differences in medial gastrocnemius cross-sectional area, muscle thickness, or echogenicity in children with CP. Although these findings are reassuring regarding the clinical use of BoNT-A in this population, the cross-sectional design does not establish causality or exclude long-term adverse effects. Larger, controlled longitudinal studies are needed to confirm these findings.