PMID- 38172891 OWN - NLM STAT- MEDLINE DCOM- 20240105 LR - 20240116 IS - 1750-1172 (Electronic) IS - 1750-1172 (Linking) VI - 19 IP - 1 DP - 2024 Jan 3 TI - Therapeutic effects of extracorporeal shock wave therapy on patients with spastic cerebral palsy and Rett syndrome: clinical and ultrasonographic findings. PG - 6 LID - 10.1186/s13023-023-03010-y [doi] LID - 6 AB - BACKGROUND: Extracorporeal shock wave therapy (ESWT) is reportedly effective for improving spasticity and motor function in children with cerebral palsy (CP). Because late-stage Rett syndrome has a similar presentation, this study aimed to investigate the effects of ESWT on these two diseases. MATERIAL AND METHODS: Patients diagnosed with spastic CP and Rett syndrome received 1500 impulses of ESWT at 4 Hz and 0.1 mJ/mm(2), on their spastic legsonce weekly for a total of 12 weeks. Outcomes were assessed before and 4 and 12 weeks after ESWT. Clinical assessments included the Modified Ashworth Scale (MAS), passive range of motion (PROM), and Gross Motor Function Measure 88 (GMFM-88). Ultrasonographic assessments included muscle thickness, acoustic radiation force impulse (ARFI), and strain elastography. RESULTS: Fifteen patients with CP and six with Rett syndrome were enrolled in this study. After ESWT, patients with CP showed significant clinical improvement in the MAS (P = 0.011), ankle PROM (P = 0.002), walking/running/jumping function (P = 0.003), and total function (P < 0.001) of the GMFM-88. The patients with Rett syndrome showed improved MAS scores (P = 0.061) and significantly improved total gross motor function (P = 0.030). Under ARFI, patients with CP demonstrated decreased shear wave speed in the gastrocnemius medial head (P = 0.038). Conversely, patients with Rett syndrome show increased shear-wave speeds after ESWT. CONCLUSION: Our study provides evidence that a weekly course of low-dose ESWT for 12 weeks is beneficial for children with both CP and Rett syndrome, with the clinical effects of reducing spasticity and improving the gross motor function of the lower limbs. The ARFI sonoelastography reveals improvement of muscle stiffness in patients with CP after ESWT, but deteriorated in patients with Rett syndrome. The diverse therapeutic response to ESWT may be caused by the MECP2 mutation in Rett syndrome, having a continuous impact and driving the pathophysiology differently as compared to CP, which is secondary to a static insult. Trial registration IRB 201700462A3. Registered 22March 2017, https://cghhrpms.cgmh.org.tw/HRPMS/Default.aspx . CI - (c) 2024. The Author(s). FAU - Su, Ting-Yu AU - Su TY AD - Department of Pediatric Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan. FAU - Huang, Yu-Chi AU - Huang YC AD - Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan. FAU - Ko, Jih-Yang AU - Ko JY AD - Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan. AD - Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan. FAU - Hsin, Yi-Jung AU - Hsin YJ AD - Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan. FAU - Yu, Min-Yuan AU - Yu MY AD - Department of Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan. FAU - Hung, Pi-Lien AU - Hung PL AUID- ORCID: 0000-0003-0673-1675 AD - Department of Pediatric Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan. flora1402@cgmh.org.tw. AD - Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan. flora1402@cgmh.org.tw. LA - eng GR - CRRPG8J0061/Chang Gung Memorial Hospital/ GR - CRRPG8J0062/Chang Gung Memorial Hospital/ GR - CRRPG8J0063/Chang Gung Memorial Hospital/ PT - Journal Article DEP - 20240103 PL - England TA - Orphanet J Rare Dis JT - Orphanet journal of rare diseases JID - 101266602 SB - IM MH - Child MH - Humans MH - Muscle Spasticity/therapy MH - *Rett Syndrome/diagnostic imaging/therapy MH - *Cerebral Palsy/diagnostic imaging/therapy/complications MH - *Extracorporeal Shockwave Therapy/adverse effects MH - Muscle, Skeletal PMC - PMC10763338 OTO - NOTNLM OT - Acoustic radiation force impulse (ARFI) OT - Cerebral palsy OT - Extracorporeal shockwave therapy OT - Gross motor function measure 88 (GMFM-88) OT - Modified ashworth scale (MAS) OT - Rett syndrome COIS- The authors declare that they have no competing interests. EDAT- 2024/01/04 11:44 MHDA- 2024/01/05 06:42 PMCR- 2024/01/03 CRDT- 2024/01/03 23:56 PHST- 2023/08/30 00:00 [received] PHST- 2023/12/19 00:00 [accepted] PHST- 2024/01/05 06:42 [medline] PHST- 2024/01/04 11:44 [pubmed] PHST- 2024/01/03 23:56 [entrez] PHST- 2024/01/03 00:00 [pmc-release] AID - 10.1186/s13023-023-03010-y [pii] AID - 3010 [pii] AID - 10.1186/s13023-023-03010-y [doi] PST - epublish SO - Orphanet J Rare Dis. 2024 Jan 3;19(1):6. doi: 10.1186/s13023-023-03010-y.