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Despite its therapeutic benefits, incomplete muscle recovery has been observed post-treatment. This study evaluated longitudinal BoNT-A effects on muscle morphology over one year in children with CP (n = 26, mean age: 5.19 years \u00b1 3.26). Three-dimensional freehand ultrasound assessed medial gastrocnemius muscle volume (MV), muscle belly length (ML), cross-sectional area (CSA), and echo intensity (EI) at baseline and at 3, 6, and 12 months post-BoNT-A. Z-score normalization accounted for natural muscle growth. Linear mixed models analyzed muscular changes over time, and repeated-measures ANOVA compared muscle parameters to an age- and severity-matched control group (n = 26, mean age: 4.98 \u00b1 2.15) at one-year follow-up. MV exhibited a declining trend at 3 (p = 0.005), 6 (p = 0.003), and 12 months (p = 0.007), while ML remained unchanged throughout follow-up (p = 0.95). The initially reduced CSA at 6 months (p = 0.0005) recovered at one year, and EI increased only at 3 months post-BoNT-A (p &lt; 0.0001). At one-year follow-up, there was a trend for reduced growth rate (MV\/month) (p = 0.035) in the intervention group, whereas the control group exhibited an increased muscle growth (p = 0.029). These findings suggest distinct recovery timelines for CSA and ML, which may explain the incomplete MV recovery and highlight substantial interindividual variation in recovery processes.<\/jats:p>","DOI":"10.3390\/toxins17070327","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T03:33:25Z","timestamp":1750995205000},"page":"327","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Botulinum Neurotoxin A-Induced Muscle Morphology Changes in Children with Cerebral Palsy: A One-Year Follow-Up Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6720-0727","authenticated-orcid":false,"given":"Charlotte","family":"Lambrechts","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7800-3354","authenticated-orcid":false,"given":"Nathalie","family":"De Beukelaer","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, 3000 Leuven, Belgium"},{"name":"Kinesiology Laboratory, Geneva University Hospitals and Geneva University, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6023-3004","authenticated-orcid":false,"given":"Ines","family":"Vandekerckhove","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6575-440X","authenticated-orcid":false,"given":"Ineke","family":"Verreydt","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7971-8079","authenticated-orcid":false,"given":"Anke","family":"Andries","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8637-8853","authenticated-orcid":false,"given":"Francesco","family":"Cenni","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9652-7437","authenticated-orcid":false,"given":"Ghislaine","family":"Gayan-Ramirez","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaat","family":"Desloovere","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, 3000 Leuven, Belgium"},{"name":"Clinical Motion Analysis Laboratory, University Hospitals Leuven, 3212 Pellenberg, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8158-5535","authenticated-orcid":false,"given":"Anja","family":"Van Campenhout","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium"},{"name":"Department of Orthopaedic Surgery, University Hospitals Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.2106\/JBJS.RVW.18.00153","article-title":"Sarcopenia, Cerebral Palsy, and Botulinum Toxin Type a","volume":"7","author":"Multani","year":"2019","journal-title":"JBJS Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.yapd.2019.04.002","article-title":"Cerebral Palsy","volume":"66","author":"Taylor","year":"2019","journal-title":"Adv. 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