STRUCTURAL AND FUNCTIONAL REMODELING OF SKELETAL MUSCLE AFTER BOTULINUM THERAPY IN CHILDREN WITH CEREBRAL PALSY (clinical and physiological study)
Keywords:
cerebral palsy, botulinum therapy, skeletal muscle, structural and functional remodeling, EMG, spasticityAbstract
The aim of the study was to investigate structural and functional changes in skeletal muscle after botulinum therapy in children with cerebral palsy (CP) based on clinical, electrophysiological, and functional parameters. A prospective clinical and physiological study was conducted with assessment of spasticity dynamics, motor function, and electromyographic characteristics of target muscles before and after administration of botulinum toxin type A. The obtained data indicate that botulinum therapy initiates a complex remodeling of skeletal muscle, including reduction of pathological activity, decreased muscle co-activation, and functional remodeling, thereby creating conditions for the restoration of motor patterns and improving the effectiveness of rehabilitation.
References
Rosenbaum P., Paneth N., Leviton A., et al. A report: The definition and classification of cerebral palsy, April 2006. Developmental Medicine & Child Neurology Supplement. 2007;109:8–14.
Graham H.K., Selber P. Musculoskeletal aspects of cerebral palsy. Journal of Bone and Joint Surgery. British Volume. 2003;85(2):157–166.
Gracies J.M. Pathophysiology of spastic paresis. I: Paresis and soft tissue changes. Muscle & Nerve. 2005;31(5):535–551.
Gracies J.M. Pathophysiology of spastic paresis. II: Emergence of muscle overactivity. Muscle & Nerve. 2005;31(5):552–571.
Lieber R.L., Fridén J. Spasticity causes a fundamental rearrangement of muscle–joint interaction. Muscle & Nerve. 2002;25(2):265–270.
Smith L.R., Lee K.S., Ward S.R., et al. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo muscle tension. Journal of Physiology. 2011;589(10):2625–2639.
Aoki K.R. Pharmacology and immunology of botulinum toxin serotypes. Journal of Neurology. 2001;248(Suppl 1):3–10.
Dressler D., Adib Saberi F. Botulinum toxin: Mechanisms of action. European Neurology. 2005;53(1):3–9.
Molenaers G., Desloovere K., Fabry G., et al. The effects of quantitative gait assessment and botulinum toxin type A on musculoskeletal surgery in children with cerebral palsy. Journal of Bone and Joint Surgery. American Volume. 2006;88(1):161–170.
Heinen F., Molenaers G., Fairhurst C., et al. European consensus table on the use of botulinum toxin type A in children with cerebral palsy. European Journal of Paediatric Neurology. 2006;10(5–6):215–225.
Gough M., Shortland A.P. Could muscle deformity in children with spastic cerebral palsy be related to impaired muscle growth and altered adaptation? Developmental Medicine & Child Neurology. 2012;54(6):495–499.
Williams P.E., Goldspink G. Changes in sarcomere length and physiological properties in immobilized muscle. Journal of Anatomy. 1978;127(Pt 3):459–468.
Koman L.A., Mooney J.F., Smith B.P., Walker F., Leon J.M. Botulinum toxin type A neuromuscular blockade in the treatment of spasticity in cerebral palsy: A randomized, double-blind, placebo-controlled trial. Journal of Pediatric Orthopaedics. 2000;20(1):108–115.
Henneman E., Somjen G., Carpenter D.O. Functional significance of cell size in spinal motoneurons. Journal of Neurophysiology. 1965;28(3):560–580.
Farmer S.F., Ingram D.A., Stephens J.A. Mirror movements studied in a patient with Klippel–Feil syndrome. Journal of Physiology. 1990;428:467–484.
Kandel E.R., Koester J.D., Mack S.H., Siegelbaum S.A. Principles of Neural Science. 6th ed. New York: McGraw-Hill; 2021.
Skvortsov I.A. Cerebral Palsy: Clinical Features, Diagnosis, and Treatment. Moscow: GEOTAR-Media; 2010. (In Russian)
Badalyan L.O., Zhurba L.T., Timonina O.V. Cerebral Palsy in Children. Moscow: Meditsina; 2008. (In Russian)
Gusev E.I., Zavalishin I.A. Neuroplasticity and recovery of motor functions. S.S. Korsakov Journal of Neurology and Psychiatry. 2012;112(6):4–10. (In Russian)
Khaibullina Z.R., Khabirov F.A. Electromyographic methods for assessing spasticity in cerebral palsy. Neurological Bulletin. 2016;48(3):34–40. (In Russian)
