{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T02:35:09Z","timestamp":1771641309384,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2019,11,23]],"date-time":"2019-11-23T00:00:00Z","timestamp":1574467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Botulinum toxin type A (BoNT-A) injections in children with cerebral palsy (CP) may negatively affect muscle growth and strength. We injected BoNT-A into the affected limbs of 14 children (4.57 \u00b1 2.28 years) with hemiplegic CP and exhibiting tip-toeing gait on the affected side and investigated the morphological alterations in the medial head of the gastrocnemius muscle (GCM). We assessed thickness of the GCM, fascicle length, and fascicle angle on the affected and unaffected sides at baseline at 4 and 12 weeks after BoNT-A injections. The primary outcome measure was the change (percentage) in GCM thickness in the affected side treated with BoNT-A in comparison with the unaffected side. The percentage of treated GCM thickness became significantly thinner at 4 and 12 weeks after BoNT-A injection than baseline. However, the percentage of fascicle length and angle in treated limbs showed no significant change from baseline 4 and 12 weeks after the injection. BoNT-A injections might reduce muscle thickness in children with spastic hemiplegic CP. Fascicle length and angle might not be affected by BoNT-A injections after correction of normal growth of the children.<\/jats:p>","DOI":"10.3390\/toxins11120688","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T03:10:00Z","timestamp":1574651400000},"page":"688","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Botulinum Toxin Injection in Children with Hemiplegic Cerebral Palsy: Correction of Growth through Comparison of Treated and Unaffected Limbs"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1791-1831","authenticated-orcid":false,"given":"You Gyoung","family":"Yi","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea"},{"name":"Department of Rehabilitation Medicine, National Traffic Rehabilitation Hospital, Gyeonggi-do 12564, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dae-Hyun","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5175-5954","authenticated-orcid":false,"given":"Dongwoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ja-Young","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mi-Hyang","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/jcsm.12287","article-title":"Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: A narrative review of the literature","volume":"9","author":"Verschuren","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kruse, A., Schranz, C., Tilp, M., and Svehlik, M. (2018). Muscle and tendon morphology alterations in children and adolescents with mild forms of spastic cerebral palsy. BMC Pediatr., 18.","DOI":"10.1186\/s12887-018-1129-4"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1111\/j.1469-8749.2010.03686.x","article-title":"Gross muscle morphology and structure in spastic cerebral palsy: A systematic review","volume":"52","author":"Barrett","year":"2010","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2526","DOI":"10.1016\/j.jbiomech.2012.07.018","article-title":"Medial gastrocnemius muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic cerebral palsy","volume":"45","author":"Barber","year":"2012","journal-title":"J. Biomech."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1111\/j.1469-8749.2011.03913.x","article-title":"Medial gastrocnemius muscle volume and fascicle length in children aged 2 to 5 years with cerebral palsy","volume":"53","author":"Barber","year":"2011","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1111\/j.1469-8749.2009.03307.x","article-title":"In vivo muscle architecture and size of the rectus femoris and vastus lateralis in children and adolescents with cerebral palsy","volume":"51","author":"Moreau","year":"2009","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chen, Y., He, L., Xu, K., Li, J., Guan, B., and Tang, H. (2018). Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0190642"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1002\/mus.24763","article-title":"Muscle histopathology in children with spastic cerebral palsy receiving botulinum toxin type A","volume":"53","author":"Valentine","year":"2016","journal-title":"Muscle Nerve"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"596","DOI":"10.3109\/09638288.2012.711898","article-title":"Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: The impact on muscle morphology and strength","volume":"35","author":"Williams","year":"2013","journal-title":"Disabil. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ridd.2017.07.002","article-title":"Longitudinal assessment of gait quality in children with bilateral cerebral palsy following repeated lower limb intramuscular Botulinum toxin-A injections","volume":"68","author":"Read","year":"2017","journal-title":"Res. Dev. Disabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1111\/dmcn.13988","article-title":"Muscle volume alterations after first botulinum neurotoxin A treatment in children with cerebral palsy: A 6-month prospective cohort study","volume":"60","author":"Alexander","year":"2018","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1111\/dmcn.12200","article-title":"Muscle volume alterations in spastic muscles immediately following botulinum toxin type-A treatment in children with cerebral palsy","volume":"55","author":"Williams","year":"2013","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s00702-008-0175-8","article-title":"Effectiveness of botulinum toxin A for upper and lower limb spasticity in children with cerebral palsy: A summary of evidence","volume":"116","author":"Lukban","year":"2009","journal-title":"J. Neural Transm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.3349\/ymj.2014.55.5.1406","article-title":"Architectural changes of the gastrocnemius muscle after botulinum toxin type A injection in children with cerebral palsy","volume":"55","author":"Park","year":"2014","journal-title":"Yonsei Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1469-8749.2010.03890.x","article-title":"Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: A systematic review","volume":"53","author":"Ryll","year":"2011","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-017-14997-3","article-title":"Injection of high dose botulinum-toxin A leads to impaired skeletal muscle function and damage of the fibrilar and non-fibrilar structures","volume":"7","author":"Pingel","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s40272-019-00344-8","article-title":"Botulinum Toxin in the Management of Children with Cerebral Palsy","volume":"21","author":"Multani","year":"2019","journal-title":"Pediatr. Drugs"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Salari, M., Sharma, S., and Jog, M.S. (2018). Botulinum toxin induced atrophy: An uncharted territory. Toxins (Basel), 10.","DOI":"10.3390\/toxins10080313"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.jos.2017.10.012","article-title":"Ultrasonographic evaluation of changes in the muscle architecture of the gastrocnemius with botulinum toxin treatment for lower extremity spasticity in children with cerebral palsy","volume":"23","author":"Kawano","year":"2018","journal-title":"J. Orthop Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.braindev.2013.05.008","article-title":"Lower limb muscle volumes in bilateral spastic cerebral palsy","volume":"36","author":"Noble","year":"2014","journal-title":"Brain Dev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.clinbiomech.2007.03.004","article-title":"Differences in gastrocnemius muscle architecture between the paretic and non-paretic legs in children with hemiplegic cerebral palsy","volume":"22","author":"Mohagheghi","year":"2007","journal-title":"Clin. Biomech."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/12\/688\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:36:57Z","timestamp":1760189817000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/12\/688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,23]]},"references-count":21,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["toxins11120688"],"URL":"https:\/\/doi.org\/10.3390\/toxins11120688","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,23]]}}}