Effect of Dysport Injections on Energy Expenditure and Walking Efficiency in Children With Cerebral Palsy

Study Overview
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Brief Summary
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This study aims to evaluate the efficacy of single event multi level chemoneurolysis with the abobotulinumtoxin A drug, Dysport®, on walking energy expenditure and gait in children with spastic diplegia cerebral palsy.

Detailed Description
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Cerebral Palsy (CP) is the leading cause of disability in children, with the most widespread type of CP being spastic CP which negatively affects physical function. Specifically it is reported that there is an increase in energy expenditure and oxygen consumption in children with CP. Single event multi level chemoneurolysis with abobotulinumtoxinA has been found to be an effective treatment for patients with spasticity to reduce energy expenditure by increasing walking efficiency; however many of these studies have conflicting methodological approaches. Therefore this study aims to evaluate the single event multilevel chemoneurolysis with Dysport® on energy expenditure and gait in children with spastic diplegia CP.

Official Title
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Effect of Single Event Multi Level Chemoneurolysis With Dysport on Energy Expenditure and Walking Efficiency

Conditions
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Cerebral Palsy

Intervention / Treatment
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* Drug: Dysport Injectable Product


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: 5-17 years. Must be <18 prior to injection. >10 kilograms at screening and injection visits Diagnosis of spastic diplegia or mild- to moderate spastic quadriplegia Cerebral Palsy Gross Motor Function Classification System level: I, II, III Ability to ambulate independently without aid, equinus gait Absent of joint or bone deformities Eligible to receive single-event multi-level chemoneurolysis (SEMLC) Cooperative and tolerant to testing procedures during clinic screening Presence of spasticity in one or both legs Be on a stable dose and regimen if on any prescribed medication/s Parent must have signed written informed consent and the Patient Authorization for Use and Release of Health and Research Study Information Exclusion Criteria: Ankle contractures no more than -10 degrees with the knee extended Hemiplegia Wheelchair dependent Received Botulinum toxin within previous 4 months Uncontrolled epilepsy or certain types of seizures Fracture in the study limb within previous 12 months Infection or skin disorder at planned injection site Shortness of breath or other respiratory issues Uncontrolled clinically significant medical condition Received phenol or alcohol block in the study limb within previous 6 months Surgery in the study limb within previous 12 months Serial casting within previous 12 months New physiotherapy and/or orthotic regimen <1 month before study start. (physiotherapy and/or orthotic regimen will be permitted if it began >1 month before study start and maintained throughout study)

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dysport Injectable Product<br>All participants will participate in baseline data collection of energy expenditure, gait analysis, and lower limb spasticity assessment. All participants will receive single event multi level chemoneurolysis with Dysport and will have repeat data collection at 4 weeks and 12 weeks post injection. | Drug: Dysport Injectable Product<br>* Selected dose of medication will be determined by affected muscle(s), severity of spasticity, and the patient's body weight. We will follow the recommended total Dysport dose of 10-15 units/kg per limb, not to exceed 15 units/kg for unilateral lower limb, 30 units/kg for bilateral lower limb, or a total of 1000 units, whichever is lower in a given session.<br>* Other names: Botulinum toxin A;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oxygen Consumption (ml/kg/Min) | Energy expenditure (oxygen consumption (VO2)) will be measured during the 6 minute walk test using a portable metabolic cart. The participants will use a 10 meter walkway to walk back and forth during the 6 minutes to coverage as much distance as possible. During this time they will be wearing a portable spirometric device that collects the oxygen consumption (VO2) per minute. | Baseline (1 week prior to injection), 4 weeks post injection, 12 weeks post injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait Velocity (cm/s) | Gait analysis will be measured by the GaitMat system while the child walks on the mat back and forth for five trials. | Baseline (1 week prior to injection), 4 weeks post injection, 12 weeks post injection | 
| Muscle Spasticity Using MAS | The Modified Ashworth Scale (MAS) measures muscle spasticity during passive stretching. Scores are on a 6-point scale and include 0, 1, 1+, 2, 3, and 4. Scores range from 0 (better outcome), which indicates no increase in muscle tone/muscle spasticity to a score of 4 (worse outcome), which indicates a rigid muscle or maximum spasticity. Each subscale is independently scored and not combined to create a composite score. When calculating the mean score, 1+ is equivalent to a value of 1.5. | Baseline (1 week prior to injection), 4 weeks post injection, 12 weeks post injection | 
| Muscle Spasticity Using MTS | The Modified Tardieu Scale (MTS) measures muscle spasticity during a passive stretch at both slow and fast speeds. Scores range from 0, which indicates no resistance throughout the course of the passive movement (better outcome), to 5, which indicates that the joint is immovable (worse outcome). The first measure determines the maximum range of motion of a target muscle group in degrees and the second measure determines the angle where muscle resistance is felt during a rapid velocity stretch, recorded in degrees. The total score is calculated by subtracting measure one from measure two. A greater difference between measures indicates less muscle spasticity. The Modified Tardieu Scale will be performed in the hamstrings, gastrocnemius, and soleus muscles. | Baseline (1 week prior to injection), 4 weeks post injection, 12 weeks post injection | 
| Score on the Cerebral Palsy Quality of Life (CP QOL) Questionnaire | The Cerebral Palsy Quality of Life (CP QOL) Questionnaire consists of 66 items ranging from 1 to 9 with a lower score indicating a higher quality of life. The total score will be calculated as well as an individual score for the seven subscale domains: Social well-being and acceptance, functioning, Participation and physical health, Emotional well-being, Access to services, pain and feeling about disability, and family health. Scoring involves 2 steps. First, items are transformed to a scale with a possible range of 0-100. The scores are recoded as follows 1 to 0, 2 to 12.5, 3 to 25, 4 to 37.5, 5 to 50, 6 to 6.2, 7 to 75, 8 to 87.5, 9 to 100. Then the algebraic mean of item values is computed from the composite score for each domain. Once rescored, the final score ranges from 0 to 100, with 0 indicating a worse outcome. | Baseline (1 week prior to injection), 4 weeks post injection, 12 weeks post injection | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Botulinum toxin A, Walking efficiency, Spasticity, Dysport, Pediatric