Intramuscular injection of collagenase clostridium histolyticum may decrease spastic muscle contracture for children with cerebral palsy. (January 2019)

• Record Type: Journal Article
• Authors: Howard, Jason J.; Huntley, James S.; Graham, H. Kerr; Herzog, Walter L.
• Is Part Of: Medical hypotheses. Volume 122(2019)
• Page Start: 126
• Page End: 128
• Publication Date: 2019-01
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Medicine; Periodicals; 610
• DOI: 10.1016/j.mehy.2018.11.002
• Languages: English
• ISSNs: 0306-9877

Abstract

Abstract: In cerebral palsy (CP), the spastic motor type is most common, associated with a velocity-dependent increase in muscle stiffness that precedes the development of fixed muscle contracture – a permanent shortening of the muscle tendon unit even when relaxed. Intra-muscular injections of botulinum toxin type A (BTX-A) have become popular for the treatment of spastic muscle contractures but unfortunately its use has not resulted in long-term functional benefits and, paradoxically, has been associated with a persistent loss of contractile material. Recent biomechanical work has shown that the stiffness of the CP muscle increases in proportion to total collagen content within the perimysial extra-cellular matrix. Thus, rather than the use of tone-reducing agents, we hypothesize that the focal use of a selective collagenase, injected into spastic muscle at an appropriate dilution and concentration, may serve to reduce the extent of muscle contracture, improving clinical range of motion and perhaps sarcomere length.