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Meta-Analysis
. 2025 Aug 1;104(8):724-729.
doi: 10.1097/PHM.0000000000002705. Epub 2025 Feb 4.

Effects of Botulinum Neurotoxin on Muscle Mass and Volume in Individuals With Spastic Cerebral Palsy: A Systematic Review and Meta-analysis

Ai-Chieh Lin  1 , Yu-Chi Su  2 , Yu-Ching Lin
Affiliations
Meta-Analysis

Effects of Botulinum Neurotoxin on Muscle Mass and Volume in Individuals With Spastic Cerebral Palsy: A Systematic Review and Meta-analysis

Ai-Chieh Lin et al. Am J Phys Med Rehabil. .

Abstract

Objective: The aim of the study was to comprehensively survey the impact of botulinum neurotoxin on muscle volume or mass in treating lower limb spasticity in individuals with spastic cerebral palsy.

Design: We searched PubMed, Embase, Web of Science, and the Cochrane Library up to May 15, 2024. We focused on changes in the volume or mass of the gastrocnemius, triceps surae, or entire distal lower limb muscles at various follow-up periods. Meta-regression analysis was conducted to assess the moderating effects of age and gross motor function classification system level.

Results: Our analysis included 11 cohort studies. A significant decrease in gastrocnemius muscle volume or mass was observed 2-3 mos after botulinum neurotoxin treatment (standardized mean difference -0.496, 95% confidence interval [-0.810, -0.181]) but not at earlier (standardized mean difference -0.134, [-0.397, 0.129]) or later (standardized mean difference -0.223, [-1.199, 0.752]) periods. The triceps surae and entire distal lower limb muscles showed no changes. Older patients ( P = 0.026) and those with Gross Motor Function Classification System I-II levels ( P = 0.0191) had more pronounced decreases.

Conclusion: The present study showed a decrease in muscle volume or mass of the botulinum neurotoxin-injected gastrocnemius after a short follow-up period but not in the triceps surae or the distal lower limb in individuals with spastic cerebral palsy.

Keywords: Botulinum Neurotoxin; Cerebral Palsy; Muscle Volume; Spasticity.

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Conflict of interest statement

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

References

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