Funding outcome

Cerebral palsy (CP) results from an injury to a child's brain before or near the time of birth from a lack of oxygen to the brain or from a stroke. CP affects muscle movement, produces excessive muscle tone and reflexes, resulting in spasticity. To reduce spasticity, Botox (BT) is often injected into the affected muscles of children with CP. BT stops the communication between the nerve and muscle and works best when it is injected where the nerve ending meets the muscle [called innervation zone (IZ)]. Needle EMG and nerve stimulation, which are painful for children, are sometimes used to help guide the BT injection but cannot accurately identify the IZ. We propose a pain-free method to locate the IZ by using a large grid of recording electrodes placed over the muscle. This novel technology will allow us to: 1) Locate the IZ in children with CP and compare it to typically developing (TD) children. By injecting at the IZ, lower doses of BT can be used in one muscle so that other muscles can be targeted during a single procedure. The location of the IZ may be different compared to a TD child due to structural changes in CP muscle. 2) Track changes in the activation pattern of the entire muscle to determine how BT affects the reconnection of the nerves to the muscle after BT wears off. These muscle recordings will tell us if the BT has truly worn off to ensure it is safe to reinject the muscle, preventing permanent damage during development. We will use this information to help guide future clinical trials to determine if lower doses of BT can be used when injected into the IZ of the muscle and help establish guidelines as to when additional doses of BT should be given.