Objective To evaluate the effects of the dilution volume of botulinum toxin A on spasticity of children with cerebral palsy. Method: Total 18 legs of 9 children with cerebral palsy were enrolled. 100 units of botulinum toxin were diluted with 4 cc or 2 cc of normal saline and injected to the medial and lateral heads of Gastrocnemius. Modified Ashworth scale, modified Tardieu test and range of motion (ROM) of ankle and knee were measured. Measurements were obtained before and at 1, 7, 14, 30, 60, 90, and 180 days after injection, respectively. Results: Spasticity tested by modified Ashworth scale and modified Tardieu test decreased and ROM of ankle and knee increased after 14 days since injection in both groups (p<0.05). In low dilution group, maximal ROM of ankle and knee was obtained at 30th day after injection. In high dilution group, maximal ROM of ankle and knee was achieved at 14th day after injection and maximal ROM of knee at 30th day after injection. However, there was no significant differences between high dilution group and low dilution group in different times. Conclusion: Management of spasticity with botulinum toxin in cerebral palsy was not related to dilution volume. (J Korean Acad Rehab Med 2008; 32: 294-299)
Objective: To know if changes in compound muscle action potential (CMAP) of human extensor digitorum brevis (EDB) muscle can be enhanced by increase in dilution volume of botulinum toxin type A.
Method: In 11 healthy volunteers, 2.5 U of botulinum toxin (BotoxⰒ, Allergen Inc.) in a volume of 0.1 ml normal saline was injected in EDB muscle and the same dose with the dilution volume of 0.5 ml was injected in the opposite side. We measured the pre- and post-injection M-wave amplitude and area of EDB muscle.
Results: The mean post/pre injection amplitude ratio of CMAP were 0.49⁑0.21 with the 0.1 ml of dilution volume and 0.40⁑0.12 with the 0.5 ml of dilution volume. The mean post/pre injection area ratio of CMAP were 0.51⁑0.18 with the 0.1 ml of dilution volume and 0.44⁑0.15 with the 0.5 ml of dilution volume. There was no significant difference between the two dilution volumes.
Conclusion: Five fold increase in dilution volume did not enhance the paralyzing effect of botulinum toxin type A in human EDB muscles.