Leucine supplementation and exercise to enhance muscle development in a child with spastic cerebral palsy: a case report

Abstract

Children with spastic cerebral palsy experience impaired muscle growth. A combination of strength exercises and amino acid supplementation may increase muscle protein synthesis, but to date no study investigated this intervention in children with cerebral palsy. Leucine is considered to play a key role in anabolic signaling in skeletal muscle cells. Therefore, we investigated the compliance to and effectiveness of L-leucine supplementation in combination with strength exercises to promote muscle growth in a child with spastic cerebral palsy. The study involved a seven-year-old girl with bilateral spastic cerebral palsy, classified as gross motor function classification system level II. She received single amino acid supplementation with 150 mg/kg/day L-Leucine combined with a plantar flexor strength exercise program during 10 weeks. Assessments included blood and urine analysis, three-dimensional freehand ultrasound of the medial gastrocnemius, three-day estimated food record, bio-electrical impedance analysis and functional plantar flexion strength measures. The overall compliance with L-Leucine intake and exercise program was 84% and 66%, respectively. No adverse events were reported. Improvement in functional muscle strength and an overall increase in fat-free mass and prealbumin levels were observed. However, the pre-existing decreased muscle size was not countered by the intervention. The intervention protocol proved to have a good compliance rate and functional improvements were observed. However, medial gastrocnemius muscle hypertrophy was not positively affected during the study period. As a next step, the study sample should be expanded, using a randomized controlled trial.