Changes of the spasticity patterns in children with cerebral palsy GMFCS III at the age of 2 to 12 years

Kurenkov A.L.; Kuzenkova L.M.; Fisenko D.A.; Klochkova O.A.; Bursagova B.I.; Chernikov V.V.

doi:https://doi.org/10.17116/jnevro202012006136

Kurenkov A.L.

National Medical Research Center for Children’s Health

SPIN RSCI: 8579-3765
Scopus AuthorID: 6603634903
ORCID: 0000-0002-7269-9100

Kuzenkova L.M.

National Medical Research Center for Children’s Health

Fisenko D.A.

Lomonosov Moscow State University

Klochkova O.A.

National Medical Research Center for Children’s Health

Bursagova B.I.

National Medical Research Center for Children’s Health

Chernikov V.V.

National Medical Research Center for Children’s Health

Changes of the spasticity patterns in children with cerebral palsy GMFCS III at the age of 2 to 12 years

Authors:

Kurenkov A.L., Kuzenkova L.M., Fisenko D.A., Klochkova O.A., Bursagova B.I., Chernikov V.V.

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Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(6): 36‑44

DOI: 10.17116/jnevro202012006136

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To cite this article:

Kurenkov AL, Kuzenkova LM, Fisenko DA, Klochkova OA, Bursagova BI, Chernikov VV. Changes of the spasticity patterns in children with cerebral palsy GMFCS III at the age of 2 to 12 years. S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(6):36‑44. (In Russ.)
https://doi.org/10.17116/jnevro202012006136

Подписка 2026 Журнал неврологии и психиатрии им. С.С. Корсакова (S.S. Korsakov Journal of Neurology and Psychiatry)

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OBJECTIVE

To study the specific patterns of spasticity in CP patients with level III according to the Gross Motor Function Classification System (GMFCS) in different age periods.

MATERIAL AND METHODS

A retrospective analysis of injection protocols of Abobotulinum toxin A for 99 patients with bilateral spastic CP GMFCS III at the age of 2 to 12 years was performed. Spasticity patterns were evaluated according to the frequency of target muscle selection for the botulinum toxin A (Abobotulinum toxin A) injections.

RESULTS

The equinus foot deformity (89.7%, 95%CI 72.8—97.2) and its combination with internal hip rotation (79.3%, 95% CI 61.3—90.5) and/or hip adduction (65.5%, 95% CI 47.3—80.2) were the main lower extremity spasticity pattern for the patients aged 2 to 4 years. Between 4 and 6 years, there was the decrease in injections to the gastrocnemius muscle (75%, 95% CI 52.8—89.2), and less to the m. gracilis (70%, 95% CI 47.9—85.7) and hip adductors (55% 95 CI 34.2—74.2). In the 6—12 year old patients, the predominant spasticity patterns were internal hip rotation (80%, 95% CI 66.8—88.9), adduction (54%, 95% CI 40.4—67.0) and knee flexion (66%, 95% CI 52.1—77.6). The leading upper extremity patterns at all observed ages were forearm pronation (70.7%, 95% CI 61.1—78.8) and elbow flexion (47.5%, 95% CI 37.9—57.2). The frequency of injections to these muscles slightly decreased in elder groups.

CONCLUSIONS

CP GMFCS III patients demonstrate age-related changes of the spasticity patterns both in lower and upper extremities. These changes and typical spastic muscles should be taken into account during the rehabilitation and botulinum toxin treatment planning, as well as in the detection and prevention of the orthopaedic complications.

Keywords:

cerebral palsy

spasticity

Gross Motor Function Classification System (GMFCS)

GMFCS III

botulinum toxin type A

Abobotulinum toxin A

multilevel injections

Authors:

Kurenkov A.L.

National Medical Research Center for Children’s Health

SPIN RSCI: 8579-3765
Scopus AuthorID: 6603634903
ORCID: 0000-0002-7269-9100

Kuzenkova L.M.

National Medical Research Center for Children’s Health

Fisenko D.A.

Lomonosov Moscow State University

Klochkova O.A.

National Medical Research Center for Children’s Health

Bursagova B.I.

National Medical Research Center for Children’s Health

Chernikov V.V.

National Medical Research Center for Children’s Health

Received:

14.04.2020

Accepted:

14.05.2020

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References:

Graham HK, Rosenbaum P, Paneth N, Dan B, Lin JP, Damiano DL, Becher JG, Gaebler-Spira D, Colver A, Reddihough DS, Crompton KE, Lieber RL. Cerebral palsy. Nat Rev Dis Primers. 2016;2:15082. https://doi.org/10.1038/nrdp.2015.82
Dayanidhi S, Lieber RL. Muscle biology of contractures in children with cerebral palsy. In book: Cerebral palsy: A Multidisciplinary Approach. Third edition. Ed. Panteliadis C.P. Cham: Springer; 2018.
Lumsden DE, Crowe B, Basu A, Amin S, Devlin A, DeAlwis Y, Kumar R, Lodh R, Lundy CT, Mordekar SR, Smith M, Cadwgan J. Pharmacological management of abnormal tone and movement in cerebral palsy. Arch Dis Child. 2019;104(8):775-780. https://doi.org/10.1136/archdischild-2018-316309
Delgado MR, Hirtz D, Aisen M, Ashwal S, Fehlings DL, McLaughlin J, Morrison LA, Shrader MW, Tilton A, Vargus-Adams J. Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010;74(4):336-343. https://doi.org/10.1212/WNL.0b013e3181cbcd2f
Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55(10):885-910. https://doi.org/10.1111/dmcn.12246
Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020;20(2):3. https://doi.org/10.1007/s11910-020-1022-z
Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, Placzek R. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel). 2015;7(5):1629-1648. https://doi.org/10.3390/toxins7051629
Multani I, Manji J, Hastings-Ison T, Khot A, Graham K. Botulinum toxin in the management of children with cerebral palsy. Paediatr Drugs. 2019;21(4):261-281. https://doi.org/10.1007/s40272-019-00344-8
Hägglund G, Wagner P. Development of spasticity with age in a total population of children with cerebral palsy. BMC Musculoskelet Disord. 2008;9:150. https://doi.org/10.1186/1471-2474-9-150
Franzén M, Hägglund G, Alriksson-Schmidt A. Treatment with Botulinum toxin A in a total population of children with cerebral palsy — a retrospective cohort registry study. BMC Musculoskelet Disord. 2017;18(1):520. https://doi.org/10.1186/s12891-017-1880-y
Kurenkov AL, Klochkova OA, Bursagova BI, Kuzenkova LM, Mamedyarov AM, Pak LA. Expansion of indications for botulinum toxin type A preparation (AbobotulinumtoxinA): the optimal approach to the selection of targeted muscles and calculation of doses with the spastic forms of infantile cerebral palsy. Farmateka. 2018;10:46-51. (In Russ.). https://doi.org/10.18565/pharmateca.2018.10.46-51
Klochkova OA, Kurenkov AL, Karimova KM, Bursagova BI, Namazova-Baranova LS, Mamedyarov AM, Kuzenkova LM, Tardova IM, Fal’kovskiy IV, Dontzov OG, Ryzhenkov MA, Zmanovskaya VA, Butorina MN, Pavlova OL, Harlamova NN, Dankov DM, Levitina EV, Popkov DA, Ryabykh SO, Medvedeva SN, Gubina EB, Vladykina LN, Kenis VM, Kiseleva TI, Krasavina DA, Vasil’eva ON, Nosko AS, Zykov VP, Michnovich VI, Belogorova TA, Rychkova LV. Multilevel Botulinum Toxin A (Abobotulinum Toxin A) Injections in Spastic Forms of Cerebral Palsy: Retrospective Analysis of 8 Russian Centers Experience. Pediatric Pharmacology. 2016;13(3):259-269. (In Russ.). https://doi.org/10.15690/pf.v13i3.1576
Heinen F, Desloovere K, Schroeder AS, Berweck S, Borggraefe I, van Campenhout A, Andersen GL, Aydin R, Becher JG, Bernert G, Caballero IM, Carr L, Valayer EC, Desiato MT, Fairhurst C, Filipetti P, Hassink RI, Hustedt U, Jozwiak M, Kocer SI, Kolanowski E, Krägeloh-Mann I, Kutlay S, Mäenpää H, Mall V, McArthur P, Morel E, Papavassiliou A, Pascual-Pascual I, Pedersen SA, Plasschaert FS, van der Ploeg I, Remy-Neris O, Renders A, Di Rosa G, Steinlin M, Tedroff K, Valls JV, Viehweger E, Molenaers G. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol. 2010;14:45-66. https://doi.org/10.1016/j.ejpn.2009.09.005
Hanna SE, Rosenbaum PL, Bartlett DJ, Palisano RJ, Walter SD, Avery L, Russell DJ. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol. 2009;51(4):295-302. https://doi.org/10.1111/j.1469-8749.2008.03196.x
Klochkova O.A. Effektivnost' botulinoterapii pri spastichnosti ruki v kompleksnoj reabilitacii detej s cerebral'nym paralichom: Dis. ... kand. med. nauk. M. 2013
Hoare BJ, Wallen MA, Imms C, Villanueva E, Rawicki HB, Carey L. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE). Cochrane Database Syst Rev. 2010;1:CD003469. https://doi.org/10.1002/14651858.CD003469.pub4
Thomason P, Rodda J, Willoughby K, Graham HK. Lower limb function. In book: Cerebral palsy: science and clinical practice. Eds. Dan B., Mayston M., Paneth N., Rosenbloom L. London: Mac Keith Press; 2014.
Rutz E, Thomason P, Willoughby K, Graham HK. Integrated management in cerebral palsy: musculoskeletal surgery and rehabilitation in ambulatory patients. In book: Cerebral palsy: A Multidisciplinary Approach. Third edition. Ed. Panteliadis Cham C.P. : Springer; 2018.
Fehlings D, Novak I, Berweck S, Hoare B, Stott NS, Russo RN.; Cerebral Palsy Institute. Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement. Eur J Neurol. 2010;17(suppl 2):38-56. https://doi.org/10.1111/j.1468-1331.2010.03127.x
Love SC, Novak I, Kentish M, Desloovere K, Heinen F, Molenaers G, O’Flaherty S, Graham HK; Cerebral Palsy Institute. Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neurol. 2010;17(suppl 2):9-37. https://doi.org/10.1111/j.1468-1331.2010.03126.x
Papavasiliou AS, Nikaina I, Bouros P, Rizou I, Filiopoulos C. Botulinum toxin treatment in upper limb spasticity: treatment consistency. Eur J Paediatr Neurol. 2012;16(3):237-242. https://doi.org/10.1016/j.ejpn.2011.07.013
Kurenkov AL, Klochkova OA, Zmanovskaya VA, Falkovskiy IV, Kenis VM, Vladykina LN, Krasavina DA, Nosko AS, Rychkova LV, Karimova KM, Bursagova BI, Namazova-Baranova LS, Mamedyarov AM, Kuzenkova LM, Dontzov OG, Ryzhenkov MA, Butorina MN, Pavlova OL, Harlamova NN, Dankov DM, Levitina EV, Popkov DA, Ryabykh SO, Medvedeva SN, Gubina EB, Agranovich OV, Kiseleva TI, Vasileva ON, Zykov VP, Mihnovich VI, Belogorova TA. The First Russian Consensus on the Multilevel Abobotulinumtoxin A Injections in Spastic Forms of Cerebral Palsy. Zhurnal Nevrologii i Psihiatrii im. S.S. Korsakova. 2016;11(116):121-130. (In Russ.). https://doi.org/10.17116/jnevro2016116111121-130
Bakheit AM. Botulinum toxin in the management of childhood muscle spasticity: comparison of clinical practice of 17 treatment centres. Eur J Neurol. 2003;10(4):415-419.