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The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A

Local botulinum toxin (BTX-A, Botox(®)) injection in overactive muscles is a standard treatment in patients with cerebral palsy. The effect is markedly reduced in children above the age of 6 to 7. One possible reason for this is the muscle volume affected by the drug. Nine patients (aged 11.5; 8.7–1...

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Autores principales: Brunner, Reinald, De Pieri, Enrico, Wyss, Christian, Weidensteiner, Claudia, Bracht-Schweizer, Katrin, Romkes, Jacqueline, Garcia, Meritxell, Ma, Norine, Rutz, Erich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141169/
https://www.ncbi.nlm.nih.gov/pubmed/37104205
http://dx.doi.org/10.3390/toxins15040267
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author Brunner, Reinald
De Pieri, Enrico
Wyss, Christian
Weidensteiner, Claudia
Bracht-Schweizer, Katrin
Romkes, Jacqueline
Garcia, Meritxell
Ma, Norine
Rutz, Erich
author_facet Brunner, Reinald
De Pieri, Enrico
Wyss, Christian
Weidensteiner, Claudia
Bracht-Schweizer, Katrin
Romkes, Jacqueline
Garcia, Meritxell
Ma, Norine
Rutz, Erich
author_sort Brunner, Reinald
collection PubMed
description Local botulinum toxin (BTX-A, Botox(®)) injection in overactive muscles is a standard treatment in patients with cerebral palsy. The effect is markedly reduced in children above the age of 6 to 7. One possible reason for this is the muscle volume affected by the drug. Nine patients (aged 11.5; 8.7–14.5 years) with cerebral palsy GMFCS I were treated with BTX-A for equinus gait at the gastrocnemii and soleus muscles. BTX-A was administered at one or two injection sites per muscle belly and with a maximum of 50 U per injection site. Physical examination, instrumented gait analysis, and musculoskeletal modelling were used to assess standard muscle parameters, kinematics, and kinetics during gait. Magnetic resonance imaging (MRI) was used to detect the affected muscle volume. All the measurements were carried out pre-, 6 weeks post-, and 12 weeks post-BTX-A. Between 9 and 15% of the muscle volume was affected by BTX-A. There was no effect on gait kinematics and kinetics after BTX-A injection, indicating that the overall kinetic demand placed on the plantar flexor muscles remained unchanged. BTX-A is an effective drug for inducing muscle weakness. However, in our patient cohort, the volume of the affected muscle section was limited, and the remaining non-affected parts were able to compensate for the weakened part of the muscle by taking over the kinetic demands associated with gait, thus not enabling a net functional effect in older children. We recommend distributing the drug over the whole muscle belly through multiple injection sites.
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spelling pubmed-101411692023-04-29 The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A Brunner, Reinald De Pieri, Enrico Wyss, Christian Weidensteiner, Claudia Bracht-Schweizer, Katrin Romkes, Jacqueline Garcia, Meritxell Ma, Norine Rutz, Erich Toxins (Basel) Article Local botulinum toxin (BTX-A, Botox(®)) injection in overactive muscles is a standard treatment in patients with cerebral palsy. The effect is markedly reduced in children above the age of 6 to 7. One possible reason for this is the muscle volume affected by the drug. Nine patients (aged 11.5; 8.7–14.5 years) with cerebral palsy GMFCS I were treated with BTX-A for equinus gait at the gastrocnemii and soleus muscles. BTX-A was administered at one or two injection sites per muscle belly and with a maximum of 50 U per injection site. Physical examination, instrumented gait analysis, and musculoskeletal modelling were used to assess standard muscle parameters, kinematics, and kinetics during gait. Magnetic resonance imaging (MRI) was used to detect the affected muscle volume. All the measurements were carried out pre-, 6 weeks post-, and 12 weeks post-BTX-A. Between 9 and 15% of the muscle volume was affected by BTX-A. There was no effect on gait kinematics and kinetics after BTX-A injection, indicating that the overall kinetic demand placed on the plantar flexor muscles remained unchanged. BTX-A is an effective drug for inducing muscle weakness. However, in our patient cohort, the volume of the affected muscle section was limited, and the remaining non-affected parts were able to compensate for the weakened part of the muscle by taking over the kinetic demands associated with gait, thus not enabling a net functional effect in older children. We recommend distributing the drug over the whole muscle belly through multiple injection sites. MDPI 2023-04-03 /pmc/articles/PMC10141169/ /pubmed/37104205 http://dx.doi.org/10.3390/toxins15040267 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Brunner, Reinald
De Pieri, Enrico
Wyss, Christian
Weidensteiner, Claudia
Bracht-Schweizer, Katrin
Romkes, Jacqueline
Garcia, Meritxell
Ma, Norine
Rutz, Erich
The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A
title The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A
title_full The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A
title_fullStr The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A
title_full_unstemmed The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A
title_short The Non-Affected Muscle Volume Compensates for the Partial Loss of Strength after Injection of Botulinum Toxin A
title_sort non-affected muscle volume compensates for the partial loss of strength after injection of botulinum toxin a
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141169/
https://www.ncbi.nlm.nih.gov/pubmed/37104205
http://dx.doi.org/10.3390/toxins15040267
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