Treatment of Spasticity in Children and Adolescents with Cerebral Palsy in Northern Europe: a CP-North Registry Study

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2021 Jul 13

PMID 34253183

Citations 13

Authors

Gunnar Hagglund

Sandra Julsen Hollung

Matti Ahonen

Guro L Andersen

Gudbjorg Eggertsdottir

Mark S Gaston

Reidun Jahnsen

Ira Jeglinsky-Kankainen

Kirsten Nordbye-Nielsen

Ilaria Tresoldi

Ann I Alriksson-Schmidt

Affiliations

Soon will be listed here.

Abstract

Background: Spasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries.

Methods: This registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland.

Results: A total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017-2018 ranged from 8.6% in Denmark to 20% in Norway (p < 0.01). Mean age for undergoing SDR ranged from 4.5 years in Norway to 7.3 years in Denmark (p < 0.01). Mean age at ITB surgery ranged from 6.3 years in Norway to 10.1 years in Finland (p < 0.01). Mean age for BTX-A treatment ranged from 7.1 years in Denmark to 10.3 years in Iceland (p < 0.01). Treatment with SDR was most common in Gross Motor Function Classification System (GMFCS) level III, ITB in level V, and BTX-A in level I. The most common muscle treated with BTX-A was the calf muscle, with the highest proportion in GMFCS level I. BTX-A treatment of hamstring and hip muscles was most common in GMFCS levels IV-V in all countries.

Conclusion: There were statistically significant differences between countries regarding the proportion of children and adolescents with CP treated with the three spasticity reducing methods, mean age for treatment and treatment related to GMFCS level. This is likely due to differences in the availability of these treatment methods and/or differences in preferences of treatment methods among professionals and possibly patients across countries.

Citing Articles

Multimodal surgical strategy for mixed refractory hypertonia in a patient with cerebral palsy: C1-2 puncture and pectoral pocket for baclofen pump implantation following lumbosacral ventral-dorsal rhizotomy. Illustrative case.

Mukherjee S, Abdelmageed S, Shahin M, Raskin J J Neurosurg Case Lessons. 2024; 8(23).

PMID: 39622025 PMC: 11616149. DOI: 10.3171/CASE24427.

Does botulinum neurotoxin A make walking easier in children with cerebral palsy? A randomized clinical trial.

Braendvik S, Ross Raftemo A, Roeleveld K, Andersen G, Ramstad K, Follestad T Dev Med Child Neurol. 2024; 67(2):263-271.

PMID: 39058740 PMC: 11695802. DOI: 10.1111/dmcn.16038.

Knee and ankle range of motion and spasticity from childhood into adulthood: a longitudinal cohort study of 3,223 individuals with cerebral palsy.

Cloodt E, Lindgren A, Rodby-Bousquet E Acta Orthop. 2024; 95:200-205.

PMID: 38708569 PMC: 11072397. DOI: 10.2340/17453674.2024.40606.

Correspondence between Expected, Perceived, and Measured Effects of BoNT-A Treatment in Calf Muscles among Children and Adolescents with Cerebral Palsy: A Mixed Methods Study.

Saether R, Elvrum A, Braendvik S J Clin Med. 2024; 13(5).

PMID: 38592286 PMC: 10933865. DOI: 10.3390/jcm13051453.

The state of the art in therapeutic administration of botulinum toxin in children with cerebral palsy: an integrative review.

Dorf S, Fonseca A, Sztajnbok F, Oliveira T, Basttistella L Rev Paul Pediatr. 2024; 42:e2023093.

PMID: 38537033 PMC: 10962635. DOI: 10.1590/1984-0462/2024/42/2023093.

References

Palisano R, Rosenbaum P, Bartlett D, Livingston M . Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008; 50(10):744-50. DOI: 10.1111/j.1469-8749.2008.03089.x. View

Cavalcanti Garcia M, Vargas C . Is somatosensory electrical stimulation effective in relieving spasticity? A systematic review. J Musculoskelet Neuronal Interact. 2019; 19(3):317-325. PMC: 6737545. View

Hirvonen M, Ojala R, Korhonen P, Haataja P, Eriksson K, Gissler M . Cerebral palsy among children born moderately and late preterm. Pediatrics. 2014; 134(6):e1584-93. DOI: 10.1542/peds.2014-0945. View

Hollung S, Hagglund G, Gaston M, Seid A, Lydersen S, Alriksson-Schmidt A . Point prevalence and motor function of children and adolescents with cerebral palsy in Scandinavia and Scotland: a CP-North study. Dev Med Child Neurol. 2021; 63(6):721-728. PMC: 8247044. DOI: 10.1111/dmcn.14764. View

Franzen M, Hagglund 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. PMC: 5725838. DOI: 10.1186/s12891-017-1880-y. View

Bugler K, Gaston M, Robb J . Distribution and motor ability of children with cerebral palsy in Scotland: a registry analysis. Scott Med J. 2018; 64(1):16-21. DOI: 10.1177/0036933018805897. View

Himmelmann K, Hagberg G, Wiklund L, Eek M, Uvebrant P . Dyskinetic cerebral palsy: a population-based study of children born between 1991 and 1998. Dev Med Child Neurol. 2007; 49(4):246-51. DOI: 10.1111/j.1469-8749.2007.00246.x. View

Brochard S, Remy-Neris O, Filipetti P, Bussel B . Intrathecal baclofen infusion for ambulant children with cerebral palsy. Pediatr Neurol. 2009; 40(4):265-70. DOI: 10.1016/j.pediatrneurol.2008.10.020. View

Maenpaa H, Salokorpi T, Jaakkola R, Blomstedt G, Sainio K, Merikanto J . Follow-up of children with cerebral palsy after selective posterior rhizotomy with intensive physiotherapy or physiotherapy alone. Neuropediatrics. 2003; 34(2):67-71. DOI: 10.1055/s-2003-39598. View

10.

Westbom L, Hagglund G, Nordmark E . Cerebral palsy in a total population of 4-11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems. BMC Pediatr. 2007; 7:41. PMC: 2248184. DOI: 10.1186/1471-2431-7-41. View

11.

Kumar R, Dhaliwal H, Kukreja R, Singh B . The Botulinum Toxin as a Therapeutic Agent: Molecular Structure and Mechanism of Action in Motor and Sensory Systems. Semin Neurol. 2016; 36(1):10-9. DOI: 10.1055/s-0035-1571215. View

12.

Alriksson-Schmidt A, Arner M, Westbom L, Krumlinde-Sundholm L, Nordmark E, Rodby-Bousquet E . A combined surveillance program and quality register improves management of childhood disability. Disabil Rehabil. 2016; 39(8):830-836. DOI: 10.3109/09638288.2016.1161843. View

13.

Rasmussen H, Nordbye-Nielsen K, Moller-Madsen B, Johansen M, Ellitsgaard N, Pedersen C . The Danish Cerebral Palsy Follow-up Program. Clin Epidemiol. 2016; 8:457-460. PMC: 5094643. DOI: 10.2147/CLEP.S99474. View

14.

Ertzgaard P, Campo C, Calabrese A . Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen. J Rehabil Med. 2017; 49(3):193-203. DOI: 10.2340/16501977-2211. View

15.

Ross Raftemo A, Mahendran A, Hollung S, Jahnsen R, Lydersen S, Vik T . Use of botulinum toxin A in children with cerebral palsy. Tidsskr Nor Laegeforen. 2019; 139(8). DOI: 10.4045/tidsskr.18.0554. View

16.

Lundkvist Josenby A, Czuba T, Alriksson-Schmidt A . Gender differences in treatments and interventions received by children and adolescents with cerebral palsy. BMC Pediatr. 2020; 20(1):45. PMC: 6993351. DOI: 10.1186/s12887-020-1926-4. View

17.

Hicks J, Schwartz M, Arnold A, Delp S . Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait. J Biomech. 2008; 41(5):960-7. PMC: 2443703. DOI: 10.1016/j.jbiomech.2008.01.002. View

18.

Hagglund G, Wagner P . Spasticity of the gastrosoleus muscle is related to the development of reduced passive dorsiflexion of the ankle in children with cerebral palsy: a registry analysis of 2,796 examinations in 355 children. Acta Orthop. 2011; 82(6):744-8. PMC: 3247896. DOI: 10.3109/17453674.2011.618917. View

19.

Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B . Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997; 39(4):214-23. DOI: 10.1111/j.1469-8749.1997.tb07414.x. View

20.

Alriksson-Schmidt A, Ahonen M, Andersen G, Eggertsdottir G, Haula T, Jahnsen R . CP-North: living life in the Nordic countries? A retrospective register research protocol on individuals with cerebral palsy and their parents living in Sweden, Norway, Denmark, Finland and Iceland. BMJ Open. 2019; 9(10):e024438. PMC: 6797311. DOI: 10.1136/bmjopen-2018-024438. View