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Is electrical stimulation beneficial for improving the paralytic effect of botulinum toxin type A in children with spastic diplegic cerebral palsy?

 Dong-wook Rha  ;  Eun Joo Yang  ;  Ho Ik Chung  ;  Hyoung Bin Kim  ;  Chang-il Park  ;  Eun Sook Park 
 YONSEI MEDICAL JOURNAL, Vol.49(4) : 545-552, 2008 
Journal Title
Issue Date
Botulinum Toxins, Type A/therapeutic use* ; Cerebral Palsy/drug therapy* ; Cerebral Palsy/physiopathology* ; Child, Preschool ; Electric Stimulation ; Electrophysiology ; Female ; Humans ; Male ; Paralysis/drug therapy* ; Paralysis/physiopathology*
Botulinum toxin type A ; electrical stimulation ; cerebral palsy ; spasticity
PURPOSE: The purpose of the present study was to investigate whether electrical stimulation (ES) improves the paralytic effect of botulinum toxin type A (BTX-A) and evaluate the differences between low frequency (LF) and high frequency (HF) ES in children with spastic diplegic cerebral palsy (CP).

MATERIALS AND METHODS: Twenty-three children with spastic diplegia CP who had BTX-A injections into both gastrocnemius muscles were assessed. Following the toxin injection, electrical stimulation was given to 1 side of the injected muscles and a sham-stimulation to the other side for 30 min a day for 7 consecutive days [HFES (25Hz) to 11 children, LFES (4Hz) to 12 children]. The compound motor action potentials (CMAP) from the gastrocnemius muscle were assessed before injection and at 5 time points (days 3, 7, 14, 21, and 30) after injection. The clinical assessments of spasticity were performed before and 30 days after injection.

RESULTS: The CMAP area became significantly lower in both LFES and HFES sides from 3 days after injection compared to baseline values. In other words, the CMAP area of the sham-stimulated side showed a significant decrease at 7 or 14 days after injection. However, there were no significant differences in clinical assessment of spasticity between the stimulated and sham-stimulated sides.

CONCLUSION: Short-term ES in both LF and HF to the spastic muscles injected with BTX-A might induce earlier denervating action of BTX-A. However, it does not necessarily lead to clinical and electrophysiological benefits in terms of reduction of spasticity.
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1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Dong Wook(나동욱) ORCID logo https://orcid.org/0000-0002-7153-4937
Park, Eun Sook(박은숙) ORCID logo https://orcid.org/0000-0002-9144-3063
Park, Chang Il(박창일)
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