Hip Lateralisation in Children with Bilateral Spastic Cerebral Palsy Treated with Botulinum Toxin Type A: A 2-Year Follow-Up

Abstract

We investigated the effect of BoNT/A injection on hip lateralisation in children with bilateral spastic cerebral palsy and bilateral adductor spasticity. Pelvic radiographs using Reimers’ migration index (MI) were evaluated from 27 children (n=9 females, n=18 males; mean age 5.2±1.96 years; range: 2–10 years; initial MI <50%) with bilateral spastic cerebral palsy over a time period of 2 years. All received injections of BoNT/A (Dysport^®) every 12 weeks with a dose of 30 Units per kilogram body weight into adductor and medial hamstring muscles on both sides. The MI was calculated before treatment and after 1 and 2 years. The mean MI increased from 25.5% (range: 0–48) to 26.7% (+1.2%, range: 0–79) on the right side and from 28.0% (range: 0–40) to 30.6% (+2.6%, range: 3–84) on the left side over 2 years, respectively. Hips of one patient dislocated bilaterally. The mean MI remained stable over 2 years. Although a specific BoNT/A effect cannot be proven because of the open design of this study, we provide strong evidence that the MI can be kept stable for a time period of 2 years under non-surgical management including therapy with BoNT/A even in CP patients with a high risk for hip dislocation.

Key words

cerebral palsy - botulinum toxin - hip - migration index

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Appendix

German Abo study group: Bad Kreuznach (Dr. G. Romberg), Beelitz (Prof. Dr. J. Wissel), Braunschweig (Dr. U. Frank), Datteln (Dr. B. Dietz), Duisburg (Dr. J. Buckard), Göttingen (Dr. K. Brockmann), Halle (Dr. C. Fritzsch), Hannover (Dr. W. Voss), Heidelberg (Dr. N. Breitbach-Faller), Hochried Murnau (Dr. E. Waldeck), Innsbruck (Dr. Müller), Karlsruhe (Dr. M. Schaechtele), Konstanz (Dr. W. Kratzer), Kreischa (Dr. W. Deppe), Landstuhl (Dr. B. Stein-Bayet), Maulbronn (Dr. G. Nass), Neunkirchen (Dr. E. Feldmann), Oldenburg (Dr. M. Wagner), Rostock (Dr. B. C. Westphal), Schwerin (Dr. D. R. Boettcher), Würzburg (Dr. M. Haeussler).

Correspondence