Influence of gait analysis on decision-marketing for lower extremity surgery

Motor pathway changes associated with upper limb botulinum toxin A therapy in children with hemiplegic cerebral palsy

T REDMAN A,B, N GIBSON A, G THICKBROOM B,C, J VALENTINE A,
J FINN B, A BREMNER B

  1. 1. Department of Paediatric Rehabilitation, Princess Margarett Hospital;
  2. 2. School of Population Health, University of Western Australia;
  3. 3. Neuromuscular Research Institute, Perth, WA, Australia

Background: Botulinum toxin A (BTX-A) therapy for spasticity management results in functional change. Both central and peripheral mechanisms are hypothesized 1. Children with hemiplegic cerebral palsy (CP) have abnormal motor pathways 2. We report the findings of a transcranial magnetic stimulation (TMS) study that aimed to document corticomotor pathway changes associated with upper limb BTX-A therapy in children with hemiplegic CP.

Design: Randomized controlled trial.

Setting: Department of Paediatric Rehabilitation, Princess Margaret Hospital and Neuromuscular Research Institute, Perth.

Participants: Twenty-two children (12 intervention, 10 control) with hemiplegic CP, aged from 7 years to 14 years !! months.

Method: Intervention: One series BTX-A injections (dose 1-2U/kg/muscle) into upper limb. TMS assessments were performed at baseline and 1,3, and 6 months post-injection. Outcome measures: Change in position of affected side TMS map at 1, 3, and 6 months post-injection.

Results: Compared with controls, at 1, 3, and 6 months, the TMS mapes for intervention children showed no significant shift. Trends observed included ipsilateral affected side maps lying significantly closer to unaffected side maps 6 month post-injection (p=0.04). TMS map shift was maximal in treatment group at 1 to 3 months post-injection, coinciding with the clinical effect. TMS map position showed up to 67% variability which was greates for ipsilateral pathways.

Conclusions: Larger studies are needed to confirm the trends seen in corticomotor pathways after upper limb BTX-A injection. The findings support a central action for BTX-A and plasticity of motor pathways.

References

  1. 1. Thickbrrom GW, Byrnes ML, Stell R, Mastaglia FL. (2003)
    2. Reversible regorganization of the motor cortical representation of the hand in cervical dystonia, Mov Disord 18: 395-402.
  2. 3. Carr Lj, Harrison LM, Evans AL, Stephens JA. (1993) Patterns of central motor reorganization in hemiplegic cerebral palsy. Brain 116: 1223-1247.
 
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