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Botulinum toxin (Dysport) treatment of the spastic gastrocnemius muscle in children with cerebral palsy: a randomized trial comparing two injection volumes

Department of Rehabilitation Medicine Mackay Memory Hospital and Mackay Medicine, Nursing and Management College, Taipei

Yao-Chia Chuang

Department of Rehabilitation Medicine Mackay Memory Hospital and Mackay Medicine, Nursing and Management College, Taipei

Jen-Pei Liu

Division of Biometry, Department of Agronomy, National Taiwan University, Taipei, Division of Biostatistics and Bioinformatics, National Health Research Institutes, Zhunan

Kuo-Liong Chien

Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, klchien{at}ha.mc.ntu.edu.tw

Yi-Min Chen

Department of Neurology Mackay Memory Hospital

Ying-Fang Chen

Department of Rehabilitation Medicine Mackay Memory Hospital and Mackay Medicine, Taipei, Taiwan

Objective: To compare the effect of equivalent doses in two different volumes of botulinum toxin type A (Dysport) on gastrocnemius spasticity.

Design: Single-blind, randomized, controlled trial.

Setting: Hospital rehabilitation department

Subjects: Twenty-two children with spastic diplegic or quadriplegic cerebral palsy.

Intervention: High (500 U/5 mL) and low (500 U/1 mL)-volume preparations of Dysport were injected into the gastrocnemius muscles, each child randomly receiving one preparation in the right and the other in the left leg.

Main measures: Dynamic ankle joint range of motion (ROM), passive ROM of the ankle joint, modified Ashworth Scale scores, and the areas of the compound muscle action potential assessed before treatment and at four and eight weeks post treatment.

Results: Both legs improved significantly. The mean (SD) improvements between baseline and the end of follow-up were 19.7 (10.83) degrees for dynamic ROM, 8.4 (9.19) degrees for passive ROM, -1.3 (0.6) for modified Ashworth Scale scores, and -9.4 (11.41) mV-ms for compound muscle action potential in the high-volume group; and 13.5 (10.45) degrees for dynamic ROM, 7.4 (7.88) for passive ROM, -0.9 (0.5) for modified Ashworth Scale scores, and -5.9 (7.50) mV-ms for areas of compound muscle action potential in the low-volume group. The high-volume preparation yielded significantly greater improvement in dynamic ROM (P<0.001), muscle tone (P < 0.001), and lower compound muscle action potential area (P = 0.006).

Conclusions: A high-volume preparation of Dysport is more effective than a low volume in reducing spasticity in the gastrocnemius muscle.

Clinical Rehabilitation, Vol. 23, No. 1, 64-71 (2009)
DOI: 10.1177/0269215508097861


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