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Botulinum neurotoxin treatment in children with cerebral palsy: validation of a needle placement protocol using passive muscle stretching and relaxing
Author(s) -
WarninkKavelaars Jessica,
Vermeulen R Jeroen,
Buizer Annemieke I,
Becher Jules G
Publication year - 2016
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13176
Subject(s) - medicine , medius , cerebral palsy , biceps , confidence interval , quadriceps femoris muscle , anesthesia , spastic , surgery , nuclear medicine , physical therapy , isometric exercise
Aim To validate a detailed intramuscular needle placement protocol using passive muscle stretching and relaxing for botulinum neurotoxin type A (Bo NT ‐A) treatment in the lower extremity of children with spastic cerebral palsy (CP), with verification by electrical stimulation. Method A prospective observational study was performed in 75 children with spastic CP who received regular Bo NT ‐A treatment under general anaesthesia (52 males, 23 females; mean age 8y 9mo, SD 3y 7mo, range 4–18y; mean body mass index 16.2, SD 3.7, range 7.7–26.7). A total of 1084 intramuscular needle placements using passive muscle stretching and relaxing were verified by electrical stimulation. Primary outcome was the positive predictive value. Results Intramuscular needle placement in the muscles adductor brevis, adductor longus, gracilis, semimembranosus, semitendinosus, biceps femoris, rectus femoris, and lateral and medial heads of the gastrocnemius and soleus had a positive predictive value ranging from 85.7% to 100% (95% confidence interval ranging from 71.5–89.9% to 91.4–100%). Interpretation This validated detailed protocol for intramuscular needle placement using passive muscle stretching and relaxing for Bo NT ‐A treatment in the lower extremity of children with spastic CP is reliable and has a high positive predictive value.