Effect of Botulinum Toxin on Muscles of Children With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      Cerebral palsy (CP) is a group of non-progressive motor dysfunction but often changing,
      secondary to injury or brain abnormalities that occur in early stages of development. In
      children with CP, the brain injury lead to a delayed motor development in the first weeks,
      associated with muscular spasticity. Drug treatments include oral treatments (baclofen and
      tizanidine) and injectable treatments like Botox (intramuscular injection) and neurolysis
      with alcohol or phenol (local injection into the nerve).

      Regarding botulinum toxin, there is no study questioning its effectiveness. However, no
      publication on the pathophysiology of human muscle of the CP child after toxin injection was
      found. The action of the toxin on the neuromuscular junction (NMJ) and muscle structure is
      unknown in children with CP.

      The primary objective of this study is to describe structural abnormalities of the CP child's
      muscle following multiple toxin injections in terms of NMJ fragmentation and axonal
      sprouting.

      Secondary objectives:

      To evaluate the relationship between:

        -  The severity of the motor impairment and muscle structural abnormalities.

        -  The clinical measure of spasticity and muscle structural abnormalities.

        -  To compare the structure spastic muscles with toxin injections and spastic muscle
           without toxin injections

      For muscles with multiple toxin injections, assessing the relationship between :

        -  The number of toxin injections and muscle structural abnormalities.

        -  The date of the first injection and muscle structural abnormalities.

        -  The total dose of injected toxin in the muscle and its structural abnormalities.

        -  The nature of the product injected in the muscle and its structural abnormalities.

      This innovative study will improve the knowledge on the effects of long-term botulinum toxin
      injections on the muscle (and therefore its safety in usual care), on the spastic muscle NMJ
      of CP children, on the pathophysiology of the CP child's muscle.

      All the visits all acts will be performed according to usual patient follow-up. Only a biopsy
      will be performed in addition, taken from an injected muscle during a planned operation. A
      biopsy may also be performed on a muscle without toxin injection if the act is made possible
      by the planned surgery. No biopsy will be made on a muscle that would not require surgery.
    


Intervention name(s): Muscle biopsy
Intervention type(s): Procedure
Intervention description(s): A biopsy (specifically done for the study) of a muscle that has already been injected with botulinum toxin before inclusion of the patient in the study will be performed, taken during a planned surgery (for tendon transfer or muscle lengthening). A biopsy of a muscle that has never been injected with botulinum toxin may be performed during surgery. No biopsy will be made on a member that would not require surgery. Thus sampling will be conducted on a muscle requiring a surgery: 2 to 3 millimeters will be taken on 10 mm muscle before transfer or lengthening.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Cerebral palsy; children; muscle spasticity; botulinum toxin injection