[Botulinum toxin treatment in children with cerebral palsy]. 2019

Tamás Terebessy, and Gyula Domos, and Dalma Hevér, and Nikoletta Horváth, and Sándor Kiss, and György Szőke
Ortopédiai Klinika,Semmelweis Egyetem, Általános Orvostudományi KarBudapest, Üllői u. 78/B, 1082.

Introduction: Botulinum toxin is used for decreasing spasticity, improving gait pattern and preventing secondary deformities and orthopedic surgeries in children with cerebral palsy. Despite its wide use, there is no evidence for the long-term beneficial effect of the toxin. Aim: The authors focused on the short-term effects of the toxin and on the subjective evaluation done by the parents about the botox treatment. Method: First, the calf muscle of 18 children was treated and casting was also performed. In our second patient group, multilevel lower limb injection was done in 12 cases. Joints' range of motion, muscle tone and spasticity were assessed before and 4-6 weeks after treatment. In ambulatory children, gait analysis was done. Side effects were recorded and parental opinion about the treatment was requested. Results: Increased ankle range of motion and decreased muscle tone and spasticity were seen in our first patient group. In the second group, hip flexion contracture became milder and hip abduction and the popliteal angle improved. However, gait analysis results only slightly changed after botox treatment. Occasional mild and transient adverse effects were observed during the pharmacologically active period of the toxin. Associate beneficial effects were also reported such as better comfort, easier movements, improving function of the non-injected upper limb, decreasing dysarthria and dysphagia. Conclusion: Our study strengthens the observation that botox treatment of the spastic calf muscle together with plaster casting can result in improved ankle dorsiflexion. Multilevel botox treatment can improve lower limb joints range of motion, however, gait pattern remains unchanged. The administration of botulinum toxin with respect to the guidelines has no major adverse effects. Further studies are needed to clarify the observed beneficial associate effects of the toxin. Orv Hetil. 2019; 160(28): 1105-1111.

UI MeSH Term Description Entries
D009128 Muscle Spasticity A form of muscle hypertonia associated with upper MOTOR NEURON DISEASE. Resistance to passive stretch of a spastic muscle results in minimal initial resistance (a "free interval") followed by an incremental increase in muscle tone. Tone increases in proportion to the velocity of stretch. Spasticity is usually accompanied by HYPERREFLEXIA and variable degrees of MUSCLE WEAKNESS. (From Adams et al., Principles of Neurology, 6th ed, p54) Clasp-Knife Spasticity,Spastic,Clasp Knife Spasticity,Spasticity, Clasp-Knife,Spasticity, Muscle
D002547 Cerebral Palsy A heterogeneous group of nonprogressive motor disorders caused by chronic brain injuries that originate in the prenatal period, perinatal period, or first few years of life. The four major subtypes are spastic, athetoid, ataxic, and mixed cerebral palsy, with spastic forms being the most common. The motor disorder may range from difficulties with fine motor control to severe spasticity (see MUSCLE SPASTICITY) in all limbs. Spastic diplegia (Little disease) is the most common subtype, and is characterized by spasticity that is more prominent in the legs than in the arms. Pathologically, this condition may be associated with LEUKOMALACIA, PERIVENTRICULAR. (From Dev Med Child Neurol 1998 Aug;40(8):520-7) Diplegic Infantile Cerebral Palsy,Little Disease,Monoplegic Cerebral Palsy,Quadriplegic Infantile Cerebral Palsy,Spastic Diplegia,CP (Cerebral Palsy),Cerebral Palsy, Athetoid,Cerebral Palsy, Atonic,Cerebral Palsy, Congenital,Cerebral Palsy, Diplegic, Infantile,Cerebral Palsy, Dyskinetic,Cerebral Palsy, Dystonic-Rigid,Cerebral Palsy, Hypotonic,Cerebral Palsy, Mixed,Cerebral Palsy, Monoplegic, Infantile,Cerebral Palsy, Quadriplegic, Infantile,Cerebral Palsy, Rolandic Type,Cerebral Palsy, Spastic,Congenital Cerebral Palsy,Diplegia, Spastic,Infantile Cerebral Palsy, Diplegic,Infantile Cerebral Palsy, Monoplegic,Infantile Cerebral Palsy, Quadriplegic,Little's Disease,Monoplegic Infantile Cerebral Palsy,Rolandic Type Cerebral Palsy,Athetoid Cerebral Palsy,Atonic Cerebral Palsy,Cerebral Palsies, Athetoid,Cerebral Palsies, Dyskinetic,Cerebral Palsies, Dystonic-Rigid,Cerebral Palsies, Monoplegic,Cerebral Palsy, Dystonic Rigid,Cerebral Palsy, Monoplegic,Diplegias, Spastic,Dyskinetic Cerebral Palsy,Dystonic-Rigid Cerebral Palsies,Dystonic-Rigid Cerebral Palsy,Hypotonic Cerebral Palsies,Hypotonic Cerebral Palsy,Mixed Cerebral Palsies,Mixed Cerebral Palsy,Monoplegic Cerebral Palsies,Spastic Cerebral Palsies,Spastic Cerebral Palsy,Spastic Diplegias
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016059 Range of Motion, Articular The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES. Passive Range of Motion,Joint Flexibility,Joint Range of Motion,Range of Motion,Flexibility, Joint
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D019274 Botulinum Toxins, Type A A serotype of botulinum toxins that has specificity for cleavage of SYNAPTOSOMAL-ASSOCIATED PROTEIN 25. Botulinum Neurotoxin Type A,Botulinum Toxin A,Botulinum Toxin Type A,Botox,Botulinum A Toxin,Botulinum Neurotoxin A,Clostridium Botulinum Toxin Type A,Clostridium botulinum A Toxin,Meditoxin,Neuronox,Oculinum,Onabotulinumtoxin A,OnabotulinumtoxinA,Vistabel,Vistabex,Neurotoxin A, Botulinum,Toxin A, Botulinum,Toxin, Botulinum A
D035002 Lower Extremity The region of the lower limb in animals, extending from the gluteal region to the FOOT, and including the BUTTOCKS; HIP; and LEG. Extremity, Lower,Lower Limb,Membrum inferius,Extremities, Lower,Limb, Lower,Limbs, Lower,Lower Extremities,Lower Limbs

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