Quantifying Effect of Onabotulinum Toxin A on Passive Muscle Stiffness in Children with Cerebral Palsy Using Ultrasound Shear Wave Elastography

ABSTRACTObjectiveA pilot study to longitudinally quantify effect of onabotulinum toxin A (BoNT-A) on passive muscle properties in children with cerebral palsy (CP) using ultrasound shear wave elastography (SWE).DesignProspective longitudinal cohort studyResultsBetween 1 and 3 months post-BoNT-A, a significant improvement in the shear modulus of the lateral gastrocnemius was found at 10° plantar flexion (PF) (-7.57 [-10.98, -5.07], p=0.02) and 0° PF (-14.74 [-18.21, -9.38], p=0.03). There was a notable, but non-significant difference in shear modulus at 20° PF, 10° PF, 0° PF between pre-BoNT-A and 1 month post-BoNT-A. Pre-BoNT-A shear modulus was not significantly different than 3 months post-BoNT-A at all foot positions. No significant differences in ankle passive range of motion or spasticity were found.ConclusionDespite no significant change in ankle range of motion or spasticity, SWE was able to detect a difference in lateral gastrocnemius passive muscle properties in children with CP following BoNT-A injections. The difference in passive muscle properties resolved by 3 months post-BoNT-A. Objective A pilot study to longitudinally quantify effect of onabotulinum toxin A (BoNT-A) on passive muscle properties in children with cerebral palsy (CP) using ultrasound shear wave elastography (SWE). Design Prospective longitudinal cohort study Results Between 1 and 3 months post-BoNT-A, a significant improvement in the shear modulus of the lateral gastrocnemius was found at 10° plantar flexion (PF) (-7.57 [-10.98, -5.07], p=0.02) and 0° PF (-14.74 [-18.21, -9.38], p=0.03). There was a notable, but non-significant difference in shear modulus at 20° PF, 10° PF, 0° PF between pre-BoNT-A and 1 month post-BoNT-A. Pre-BoNT-A shear modulus was not significantly different than 3 months post-BoNT-A at all foot positions. No significant differences in ankle passive range of motion or spasticity were found. Conclusion Despite no significant change in ankle range of motion or spasticity, SWE was able to detect a difference in lateral gastrocnemius passive muscle properties in children with CP following BoNT-A injections. The difference in passive muscle properties resolved by 3 months post-BoNT-A. Corresponding Author: Joline E. Brandenburg, MD, Department of Physical Medicine and Rehabilitation, Mayo Clinic – 200 First Street SW, Rochester, MN 55905 Author Disclosures: We would like to disclose that National Institutes of Health (NIH) (grants KL2TR000136, K12HD00109, F30 AG044075) and the Mayo Clinic Department of Physical Medicine and Rehabilitation for supported this research. In addition, this publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). We would also like to disclose that there may be a perceived conflict of interest for author Pengfei Song, PhD, due to patents and licensing in the field of ultrasound elastography. A portion of this work was presented at the Association of Academic Physiatrists Annual Meeting in Sacramento, California on February 20th, 2016 as part of the Rehabilitation Medicine Scientist Training Program Presentations. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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