Urine hydroxyproline correlates with progression of spasticity in cerebral palsy

Introduction:Most Cerebral Palsy (CP) patients develop muscle spasticity which is characterized by jerky movements and muscle and joint stiffness. This increase of muscle stiffness in spastic CP has been correlated with the accumulation of collagen in the muscle as detected by the increase in muscle hydroxyproline, a major component of collagen.Material and Methods:This was a cross sectional comparative study, conducted in the tertiary hospital, Malaysia from June’2012 to December’2014. Children with spastic CP (6 to 18 years) who were scheduled for muscle/tendon lengthening as part of the on going management and children with pure spasticity were included in this study. Normal children who are aged and sex matched to the CP children were included. Muscle biopsy and urine samples were collected for MH and UH analysis respectively.Results:A total of 48 children, aged 6 to 18 years (17 normal; 16 spastic CP without contracture, 15 spastic CP with contracture) were included in this study. Muscle biopsy (only for CP children with contracture) and urine samples were collected. A significant negative correlation was noted between the MH (261.894±69.077ng/ml) and UH (13.266±7.999ng/ml) levels (p=0.031). There was a statistically significant correlation between UH levels and the MAS score (p=0.01), and GMFCS score (p=0.015).Conclusions:UH quantification may be an objective tool to estimate the severity and progression of spasticity in CP.Objectives:The objective of the study is to determine if there is any correlation between muscle and urine hydroxyproline levels in spastic CP. Further, to determine if Urine Hydroxyproline levels are different between spastic CP with and without contracture. Finally to determine if UH levels can be correlated with severity of CP as determined by Modified Ashworth Scale (MAS) and Gross Motor Function Classification System (GMFCS) scores.