The efficiency of high dose botulinum toxin type-A in the treatment of cerebral palsy

Abstract

Objective: Cerebral palsy is the most common cause of severe physical disability in childhood. Botulinum toxin type A (BTX-A), has rapidly gained acceptance as a different treatment for spasticity. However, no consensus exists among clinicians about optimal dose of BTX-A in pediatric patients. Doses of 2-6 U/ kg bodyweight with a maximum total dose of 29U/kg have been reported. This study was conducted due to uncertain dosage rage in pediatric use. Method: In this study, 12 patients with cerebral palsy and spastic eqinus foot deformity who referred to our center, were treated with BTX-A in the dosage of 25 U/kg. After treatment of BTX-A, patients were followed up total of 6 months. Three months after treatment, Gross motor functional measurement (GMFM) and Modified Ashwort scale (MAS) were done. At the same time, questionnaires (PCQ) were filled for possible side effects. Results: Average age of 6 girls and 6 boys were 4.5 ± 2.8 years. GMFM and MAS were done before and 3 months after treatment and were found statistically significant (p

Keywords

• Botulinum toxin, cerebral palsy, medical treatment.

Serebral palsi tedavisinde yüksek doz botulinum toksini tip-A tedavisinin etkinliği

Abstract

Amaç: Serebral palsi, çocukluk dönemindeki ağır fiziksel yetersizliğin sık görülen sebeplerinden birisidir. Botulinum toksini tip-A (BTX-A), farklı bir tedavi yolu olarak yaygın olarak kabul görmektedir. Bununla beraber, BTX-A\'nın pediatrik optimal dozunun saptanması konusunda, klinisyenler arasında ortak bir konsensus mevcut değildir. Vücut ağırlığı kilogram başına 2-6 Ünitelik dozlardan, maksimum 29 ünite/kg\'lik total doza kadar kullanıldığı bildirilmiştir. Pediatrik kullanım dozu hala kesin olmadığı için bu çalışma yapılmıştır. Yöntemler: Bu çalışmada, rehabilitasyon merkezlerinden sevk edilen serebral palsi (SP) tanılı ve spastik ekinöz deformitesi alan toplam 12 hastaya 25 U/kg BTX-A tedavisi uygulandı. Tedavi sonrası, tüm hastalar toplam 6 ay takip edildi. Tedavinin 3. ayında Gros Motor Fonksiyon Ölçümü (GMFÖ) ve Modifiye Ashwort Skorlaması (MAS) yapıldı. Aynı zamanda, BTX-A tedavi sonrası yan etkiler, çocuk hasta sorgulama formu (ÇHS) ile incelendi. Bulgular: Altı kız ve 6 erkek hastanın yaş ortalaması 4,5 ± 2,8 yıl idi. Tedavi öncesi ve tedavi sonrası 3. ayda yapılan GMFÖ ve MAS skorlaması arasında istatistiksel olarak anlamlı fark bulundu (p

Keywords

• Botulinum toksini, serebral palsi, medikal tedavi

References

1. Koman LA, Smith BP, Shilt JS . Cerebral palsy. Lancet 2004;363:1619-1631.
2. Corry IS, Cosgrove AP, Duffy CM, et al. Botulinum toxin A compared with stretching casts in the treatment of spastic equines: a randomized prospective trial. J Pe- diatr Orthop 1998;18:304-311.
3. Jefferson RJ. Botulinum toxin in the management of cerebral palsy Dev Med Child Neurol 2004;46:491- 499.
4. Koman LA, Mooney JF, Smith BP, et al. Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a random- ized, double-blind, placebo-controlled trial. J Pediatr Orthop 2012;20:108-115.
5. Edgar TS . Clinical utility of botulinum toxin in the treat- ment of cerebral palsy: comprehensive review. J Child Neurol. 2011;16:37-46.
6. Kita M, Goodkin DE . Drugs used to treat spasticity. Drugs 2000;59:487-495.
7. Priess RA, Condie DN, Rowley DI, Graham HK. The effects of botulinum toxin (Btx-A) on spasticity of the lower limb and on gait in cerebral palsy. J Bone Joint Surg Br.2003; 85:943-948.
8. Bakheit AMO, Severa S, Cosgrove A, et al. Safety profile and efficacy of botulinum toxin A (Dysport) in children with muscle spasticity. Dev Med Child Neurol 2011;43:234-238.

9. Bakheit AMO, Ward CD, McLellan DL. Generalised botulism-like syndrome after the intramuscular injec- tions of botulinum toxin type A: a report of two cases. J Neurol Neurosurg Psychiatry 1997; 62:198-204.
10. Graham HK, Aoki KR, Autti-Ramo I, et al . Recom- mendations for the use of botulinum toxin type A in the management of cerebral palsy. Gait Posture 2000;11:67-79.
11. Bell KR, Williams E. Use of botulinum toxin type A and type B for spasticity in upper and lower limbs. Phys Med Rehabil Clin N Am 2003;14:821-835.
12. Wissel J, Heinen F, Schenkel A, et al . Botulinum toxin A in the management of spastic gait disorders in chil- dren and young adults with cerebral palsy: a random- ized, double-blind study of “high-dose” versus “low- dose” treatment. Neuropediatrics 2012;30:120-124.
13. Wong V. Use of botulinum toxin injection in 17 chil- dren with spastic cerebral palsy. Pediatr Neurol 1998;18:124-130.
14. Sutherland DH, Kaufman KR, Wyatt MP, et al. Dou- ble-blind study of botulinum A toxin injections into the gastrocnemius muscle in patients with cerebral palsy. Gait Posture. 1999;10:1-9.
15. Boyd RN, Pliatsios V, Starr R, et al . Biomechanical transformation of the gastroc-soleus muscle with bot- ulinum toxin A in children with cerebral palsy. Dev Med Child Neurol 2000;42:32-41.
16. Russell DJ, Rosenbaum PL, Avery LM, Lane M. Gross Motor Function Measure (GMFM-66 and GMFM-88) User’s Manual. London, United Kingdom: Mac Keith Pres 2012:326-335
17. Tilton AH . Management of spasticity in children with cerebral palsy. Semin Pediatr Neurol 2004;3;58-65.
18. Damiano DL, Dodd K, Taylor NF (). Should we be testing and training muscle strength in cerebral palsy? Dev Med Child Neurol 2002;44:68-72.
19. Graham H.K, Aoki and Autti-Ramo I.et a l. Recom- mendations for the use of botulinum toxin type A in the management of cerebral palsy. Gait Posture 2000; 11:67-79.
20. Baker R., Jasinski and MaciagTymecka I.et al. Bot- ulinum toxin treatment of spasticity in diplegic cere- bral palsy A randomized, double-blind, placebo-con- trolled, dose-ranging study. Dev Med Child Neurol 44;2002:666-675.