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Jardon M, Nguyen J, Casaletto E, Ko L, Wolff A, Daluiski A, Nwawka OK. Utilization of shear wave elastography to quantify and predict response to upper extremity botulinum toxin injections in patients with cerebral palsy: A pilot study. Clin Neurol Neurosurg 2023; 230:107798. [PMID: 37236005 DOI: 10.1016/j.clineuro.2023.107798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Shear wave elastography (SWE) was used to quantify change in upper extremity muscle stiffness in patients with unilateral spastic cerebral palsy (USCP) following botulinum toxin A (BTX-A) therapy. We hypothesized that SWE measures would decrease following ultrasound-guided BTX-A injection, and correlate with functional improvement. METHODS SWE measures of BTX-A treated muscles were recorded immediately pre-injection, and at 1-, 3- and 6-months post-injection. At the same timepoints, functional assessment was performed using the Modified Ashworth Scale (MAS), and passive and active range of motion (PROM and AROM) measures. Correlation of SWE with MAS, PROM and AROM, as well as the relationship between change in SWE and change in MAS, PROM and AROM was determined using Spearman's rank correlation coefficient and generalized estimating equation modeling. RESULTS 16 muscles were injected and longitudinally assessed. SWE and MAS scores decreased following BTX-A injection (p = 0.030 and 0.004, respectively), reflecting decreased quantitative and qualitative muscle stiffness. Decreased SWE reached statistical significance at 1- and 3-months, and 1-, 3- and 6-months for MAS. When comparing relative change in SWE to relative change in AROM, larger change in SWE strongly correlated with positive change in AROM (p-value range:<0.001-0.057). BTX-A responders also demonstrated lower baseline SWE (1.4 m/s) vs. non-responders (1.9 m/s), p = 0.035. CONCLUSION Ultrasound-guided BTX-A injections in patients with USCP resulted in decreased quantitative and qualitative muscle stiffness. Strong correlation between change in SWE and AROM, as well as the significant difference in baseline SWE for BTX-A responders and non-responders, suggests SWE may provide a useful tool to predict and monitor BTX-A response.
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Affiliation(s)
- Meghan Jardon
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Joseph Nguyen
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Emily Casaletto
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Aviva Wolff
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Aaron Daluiski
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
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De Beukelaer N, Weide G, Huyghe E, Vandekerckhove I, Hanssen B, Peeters N, Uytterhoeven J, Deschrevel J, Maes K, Corvelyn M, Costamagna D, Gayan-Ramirez G, Van Campenhout A, Desloovere K. Reduced Cross-Sectional Muscle Growth Six Months after Botulinum Toxin Type-A Injection in Children with Spastic Cerebral Palsy. Toxins (Basel) 2022; 14:toxins14020139. [PMID: 35202166 PMCID: PMC8876834 DOI: 10.3390/toxins14020139] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/10/2022] [Indexed: 12/17/2022] Open
Abstract
Botulinum Neurotoxin type-A (BoNT-A) injections are widely used as first-line spasticity treatment in spastic cerebral palsy (SCP). Despite improved clinical outcomes, concerns regarding harmful effects on muscle morphology have been raised. Yet, the risk of initiating BoNT-A to reduce muscle growth remains unclear. This study investigated medial gastrocnemius (MG) morphological muscle growth in children with SCP (n = 26, median age of 5.2 years (3.5)), assessed by 3D-freehand ultrasound prior to and six months post-BoNT-A injections. Post-BoNT-A MG muscle growth of BoNT-A naive children (n = 11) was compared to (a) muscle growth of children who remained BoNT-A naive after six months (n = 11) and (b) post-BoNT-A follow-up data of children with a history of BoNT-A treatment (n = 15). Six months after initiating BoNT-A injection, 17% decrease in mid-belly cross-sectional area normalized to skeletal growth and 5% increase in echo-intensity were illustrated. These muscle outcomes were only significantly altered when compared with children who remained BoNT-A naive (+4% and -3%, respectively, p < 0.01). Muscle length growth persevered over time. This study showed reduced cross-sectional growth post-BoNT-A treatment suggesting that re-injections should be postponed at least beyond six months. Future research should extend follow-up periods investigating muscle recovery in the long-term and should include microscopic analysis.
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Affiliation(s)
- Nathalie De Beukelaer
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Guido Weide
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Laboratory for Myology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 Amsterdam, The Netherlands
| | - Ester Huyghe
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Ines Vandekerckhove
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Britta Hanssen
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Science, Ghent University, 9000 Ghent, Belgium
| | - Nicky Peeters
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Rehabilitation Science, Ghent University, 9000 Ghent, Belgium
| | - Julie Uytterhoeven
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Jorieke Deschrevel
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Karen Maes
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Marlies Corvelyn
- Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Domiziana Costamagna
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Stem Cell Biology and Embryology, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Anja Van Campenhout
- Unit of Pediatric Orthopedics, Department of Orthopedics, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
| | - Kaat Desloovere
- Neurorehabilitation Group, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, 3212 Leuven, Belgium
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3
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MRI changes in calf muscles of two children with cerebral palsy following Botulinum Toxin Type A injections: a preliminary report. J Pediatr Orthop B 2022; 31:e81-e84. [PMID: 33038149 DOI: 10.1097/bpb.0000000000000816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intramuscular injections of Botulinum Toxin Type A (BoNT-A) in children with spastic cerebral palsy (CP) have been introduced in clinical practice with the aim of reducing muscle tone, preventing muscle contractures and, ultimately, improving function. The aim of this study was to evaluate prospectively the MRI changes in the calf muscles, gastrocnemius (GN) and soleus (S) of two children with unilateral spastic CP (US-CP), prior and more than 1-year following BoNT-A injections. Two male patients with US-CP were injected at the level of the GN and S muscles. Patients underwent a first lower extremity MRI prior to the first BoNT-A injection at the level of GN and S muscles of the affected side. A second MRI was perfomed 34 and 22 months after the index procedure, respectively. Both legs were investigated together symmetrically, to allow a precise comparison between muscles and structures. The MRI protocol included three sequences: axial-T2 weighted tse, SPACE and axial-T1 weighted. We found that BoNT-A injected GN and S muscles had increased signal intensity on the MRI performed 22 and 34 months after index procedure, when compared to the contralateral, not placebo injected (NaCl) leg. To the best of our knowledge, no previous studies have investigated the changes induced in muscle structures in ambulatory children with US-CP managed by BoNT-A injections. Level of evidence: II.
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Peeters N, Van Campenhout A, Hanssen B, Cenni F, Schless SH, Van den Broeck C, Desloovere K, Bar-On L. Joint and Muscle Assessments of the Separate Effects of Botulinum NeuroToxin-A and Lower-Leg Casting in Children With Cerebral Palsy. Front Neurol 2020; 11:210. [PMID: 32373040 PMCID: PMC7187925 DOI: 10.3389/fneur.2020.00210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/09/2020] [Indexed: 12/14/2022] Open
Abstract
Botulinum NeuroToxin-A (BoNT-A) injections to the medial gastrocnemius (MG) and lower-leg casts are commonly combined to treat ankle equinus in children with spastic cerebral palsy (CP). However, the decomposed treatment effects on muscle or tendon structure, stretch reflexes, and joint are unknown. In this study, BoNT-A injections to the MG and casting of the lower legs were applied separately to gain insight into the working mechanisms of the isolated treatments on joint, muscle, and tendon levels. Thirty-one children with spastic CP (GMFCS I-III, age 7.4 ± 2.6 years) received either two weeks of lower-leg casts or MG BoNT-A injections. During full range of motion slow and fast passive ankle rotations, joint resistance and MG stretch reflexes were measured. MG muscle and tendon lengths were assessed at resting and at maximum dorsiflexion ankle angles using 3D-freehand ultrasound. Treatment effects were compared using non-parametric statistics. Associations between the effects on joint and muscle or tendon levels were performed using Spearman correlation coefficients (p < 0.05). Increased joint resistance, measured during slow ankle rotations, was not significantly reduced after either treatment. Additional joint resistance assessed during fast rotations only reduced in the BoNT-A group (-37.6%, p = 0.013, effect size = 0.47), accompanied by a reduction in MG stretch reflexes (-70.7%, p = 0.003, effect size = 0.56). BoNT-A increased the muscle length measured at the resting ankle angle (6.9%, p = 0.013, effect size = 0.53). Joint angles shifted toward greater dorsiflexion after casting (32.4%, p = 0.004, effect size = 0.56), accompanied by increases in tendon length (5.7%, p = 0.039, effect size = 0.57; r = 0.40). No associations between the changes in muscle or tendon lengths and the changes in the stretch reflexes were found. We conclude that intramuscular BoNT-A injections reduced stretch reflexes in the MG accompanied by an increase in resting muscle belly length, whereas casting resulted in increased dorsiflexion without any changes to the muscle length. This supports the need for further investigation on the effect of the combined treatments and the development of treatments that more effectively lengthen the muscle.
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Affiliation(s)
- Nicky Peeters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | | | - Britta Hanssen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - Francesco Cenni
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - Simon-Henri Schless
- Motion Analysis and Biofeedback Laboratory, Alyn Hospital, Jerusalem, Israel
| | | | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, UZ Leuven, Pellenberg, Belgium
| | - Lynn Bar-On
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, Netherlands
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Ateş F, Yucesoy CA. Botulinum toxin type-A affects mechanics of non-injected antagonistic rat muscles. J Mech Behav Biomed Mater 2018; 84:208-216. [DOI: 10.1016/j.jmbbm.2018.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/18/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
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Efficacy of Repeated Botulinum Toxin Type A Injections for Spastic Equinus in Children with Cerebral Palsy-A Secondary Analysis of the Randomized Clinical Trial. Toxins (Basel) 2017; 9:toxins9080253. [PMID: 28825663 PMCID: PMC5577587 DOI: 10.3390/toxins9080253] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/08/2017] [Accepted: 08/18/2017] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin A is considered an important tool to control spasticity in children with cerebral palsy. Several factors are known to affect the efficacy of botulinum toxin, such as dosage, appropriate muscle selection and application, age, and accompanying therapy. A multicenter, double-blind, randomized, prospective phase III clinical trial of botulinum toxin A for the treatment of dynamic equinus in 144 children with cerebral palsy was performed to compare the efficacies of letibotulinumtoxin A and onabotulinumtoxin A. Secondary analyses were performed to evaluate factors that affected the outcome, focusing on the number of times injections were repeated. Effectiveness was defined as a change of 2 or more in the physician’s rating scale. Multivariate regression analyses were performed with multiple variables. The first injection of botulinum toxin A significantly improved D subscale of Gross Motor Function Measure-88 scores at 3 months compared to repeated injections (p < 0.05). After 6 months, patients who had one injection or none before the study showed significantly better outcomes than those who had more than one injection in terms of observational gait scores.
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Chaléat-Valayer E, Bernard JC, Deceuninck J, Roussouly P. Pelvic-Spinal Analysis and the Impact of Onabotulinum toxin A Injections on Spinal Balance in one Child With Cerebral Palsy. Child Neurol Open 2017; 3:2329048X16679075. [PMID: 28503621 PMCID: PMC5417343 DOI: 10.1177/2329048x16679075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/29/2016] [Accepted: 09/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background: In children with cerebral palsy, primary (eg, abnormal muscle tone and weakness) and secondary impairments (eg, contractures) can modify pelvic-spinal alignment. The main aim of this article was to establish a new approach to pelvic-spinal analysis in children with cerebral palsy, taking into account the whole pelvis-spine complex, illustrated by a case study. Methods: This is a case study of an ambulatory child with cerebral palsy (spastic diplegia) who underwent analysis of the pelvic-spine complex from X-ray images taken in standing position from C2 to the proximal femur. Pelvic shape was characterized by the pelvic incidence angle, which is the sum of sacral slope and pelvic tilt, before and after the treatment by regular onabotulinumtoxinA injections into the hip flexors, and the use of soft lumbar brace over 5 years. Results: The sagittal balance of the spine was improved following the treatment, with a reduction in lumbar lordosis and sacral slope. The reduction in lumbar hyperextension likely reduced the risk of spondylolysis, low back pain, and degenerative spondylolisthesis in adulthood. Conclusion: A biomechanical approach to the evaluation of the pelvic-spinal complex offers new perspectives to increase the understanding of spinal balance in children with cerebral palsy, providing more options for treatment, such as onabotulinumtoxinA.
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Affiliation(s)
| | - Jean-Claude Bernard
- Rehabilitation and Physical Medicine, CMCR des Massues, Croix-Rouge Française, Lyon Cedex, France
| | | | - Pierre Roussouly
- Orthopaedic Surgery Department, CMCR des Massues, Croix-Rouge Française, Lyon Cedex, France
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Jarrett C, McDaid A. Virtual Normalization of Physical Impairment: A Pilot Study to Evaluate Motor Learning in Presence of Physical Impairment. Front Neurosci 2017; 11:101. [PMID: 28381985 PMCID: PMC5361658 DOI: 10.3389/fnins.2017.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/15/2017] [Indexed: 11/13/2022] Open
Abstract
Motor learning is a critical component of the rehabilitation process; however, it can be difficult to separate the fundamental causes of a learning deficit when physical impairment is a confounding factor. In this paper, a new technique is proposed to augment the residual ability of physically impaired patients with a robotic rehabilitation exoskeleton, such that motor learning can be studied independently of physical impairment. The proposed technique augments the velocity of an on-screen cursor relative to the restricted physical motion. Radial Basis Functions (RBFs) are used to both model velocity and derive a function to scale velocity as a function of workspace position. Two variations of the algorithm are presented for comparison. In a cross-over pilot study, healthy participants were recruited and subjected to a simulated impairment to constrain their motion, imposed by the cable-driven wrist exoskeleton. Participants then completed a sinusoidal tracking task, in which the algorithms were statistically shown to augment the cursor velocity in the constrained state such that it matched position-dependent velocities recorded in the healthy state. A kinematic task was then designed as a motor-learning case study where the algorithms were statistically shown to allow participants to achieve the same performance when their motion was constrained as when unconstrained. The results of the pilot study provide motivation for further research into the use of this technique, thus providing a tool with which motor-learning can be studied in neurologically impaired populations. This could be used to give physiotherapists greater insight into underlying causes of motor learning deficits, consequently facilitating and enhancing subject-specific therapy regimes.
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Affiliation(s)
- Christopher Jarrett
- Department of Mechanical Engineering, Faculty of Engineering, University of Auckland Auckland, New Zealand
| | - Andrew McDaid
- Department of Mechanical Engineering, Faculty of Engineering, University of Auckland Auckland, New Zealand
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Kahraman A, Seyhan K, Değer Ü, Kutlutürk S, Mutlu A. Should botulinum toxin A injections be repeated in children with cerebral palsy? A systematic review. Dev Med Child Neurol 2016; 58:910-7. [PMID: 27103334 DOI: 10.1111/dmcn.13135] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to determine the effects of repeat botulinum toxin A (BoNT-A) injections in children with spastic cerebral palsy (CP) on the basis of a best evidence synthesis. METHOD This study included 13 original articles after searching the literature to retrieve information. We used the critical review form produced by McMaster University to determine the methodological quality of the studies, and then confirmed the levels of evidence from Sackett. The studies were also evaluated using the International Classification of Function, Disability and Health - Children and Youth Version (ICF-CY). RESULTS A total of 893 children with spastic CP who had been administered repeat BoNT-A injections were evaluated. The evidence level was II in four of the thirteen studies, III in four studies, and IV in five studies. The McMaster review form score was 14 in two studies, 13 in four studies, and 12 in seven studies. The results showed that repeat BoNT-A may be a safe and an effective approach. The first two injections/one repeat especially relieve spasticity and improve fine and gross motor activities. INTERPRETATION Future studies to investigate the effectiveness of repeat BoNT-A in children with spastic CP may be planned within the framework of the ICF-CY to include well-designed randomized controlled trials and those conducted on larger homogenous groups.
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Affiliation(s)
- Aysu Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Kübra Seyhan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, Ankara, Turkey
| | - Ünal Değer
- Eastern Mediterranean University, Famagusta, Turkish Republic of Northern Cyprus
| | - Seval Kutlutürk
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Akmer Mutlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazari, Ankara, Turkey
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Jiang S, Ichihara S, Prunières G, Peterson B, Facca S, Xu WD, Liverneaux P. Robot-assisted C7 nerve root transfer from the contralateral healthy side: A preliminary cadaver study. HAND SURGERY & REHABILITATION 2016; 35:95-9. [PMID: 27117122 DOI: 10.1016/j.hansur.2015.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/31/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
Patients with cerebral palsy and spastic hemiplegia may have extremely poor upper extremity function. Unfortunately, many current therapies and treatments for patients with spastic hemiplegia offer very limited improvements. One innovative technique for treating these patients is the use a contralateral C7 nerve root transfer to neurotize the C7 nerve root in the affected limb. This may result not only in less spasticity in the affected limb, but also improved control and motor function vis-a-vis the new connection to the normal cerebral hemisphere. However, contralateral C7 transfers can require large incisions and long nerve grafts. The aim of this study was to test the feasibility of a contralateral C7 nerve root transfer procedure with the use of a prevertebral minimally invasive robot-assisted technique. In a cadaver, both sides of the C7 root were dissected. The right recipient C7 root was resected as proximally as possible, while the left donor C7 root was resected as distally as possible. With the use of the da Vinci (®) SI surgical robot (Intuitive Surgical ™, Sunnyvale, CA, USA), we were able to eliminate the large incision and use a much shorter nerve graft when performing contralateral C7 nerve transfer.
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Affiliation(s)
- Su Jiang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Satoshi Ichihara
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France; Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan
| | - Guillaume Prunières
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - Brett Peterson
- Department of Orthopedic Surgery, SCPMG Orange County, Irvine, CA, USA
| | - Sybille Facca
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Philippe Liverneaux
- Department of Hand Surgery, SOS main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, Icube CNRS 7357, 10, avenue Baumann, 67400 Illkirch, France.
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Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, Placzek R. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel) 2015; 7:1629-48. [PMID: 25969944 PMCID: PMC4448165 DOI: 10.3390/toxins7051629] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin A (BoNT-A) is considered a safe and effective therapy for children with cerebral palsy (CP), especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS) of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.
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Affiliation(s)
- Walter Strobl
- Department of Paediatric- and Neuro-Orthopaedics, Orthopaedic Hospital Rummelsberg, 90592 Schwarzenbruck, Germany and MOTIO, 1080 Vienna, Austria.
| | - Tim Theologis
- Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road Headington, Oxford OX3 7LD, Oxfordshire, UK.
| | - Reinald Brunner
- Department of Paediatric- and Neuro-Orthopaedics, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland.
| | - Serdar Kocer
- Centre de Réadaptation de COUBERT (Ugecam) 77170, France and ROMATEM, Etiler Istanbul 34337, Turkey.
| | - Elke Viehweger
- Pediatric Orthopaedics and Institue of Motion Sciences Department, Aix-Marseille Université, Boulevard Jean Moulin, Marseille 13885, France.
| | - Ignacio Pascual-Pascual
- Department of Paediatrics, Hospital Infantil La Paz, Universidad Autonóma de Madrid, Madrid, Spain.
| | - Richard Placzek
- Orthopedic Department, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
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Yucesoy CA, Turkoğlu AN, Umur S, Ateş F. Intact muscle compartment exposed to botulinum toxin type a shows compromised intermuscular mechanical interaction. Muscle Nerve 2014; 51:106-16. [DOI: 10.1002/mus.24275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Can A. Yucesoy
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
| | - Ahu Nur Turkoğlu
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
| | - Sevgi Umur
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
| | - Filiz Ateş
- Biomedical Engineering Institute; BoğaziÇi University; 34684 Çengelköy Istanbul Turkey
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Effects of botulinum toxin type A on non-injected bi-articular muscle include a narrower length range of force exertion and increased passive force. Muscle Nerve 2014; 49:866-78. [DOI: 10.1002/mus.23993] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 01/09/2023]
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Turkoglu AN, Huijing PA, Yucesoy CA. Mechanical principles of effects of botulinum toxin on muscle length–force characteristics: An assessment by finite element modeling. J Biomech 2014; 47:1565-71. [DOI: 10.1016/j.jbiomech.2014.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/26/2014] [Accepted: 03/11/2014] [Indexed: 11/27/2022]
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Zonta MB, Bruck I, Puppi M, Muzzolon S, Neto ADC, Coutinho dos Santos LH. Effects of early spasticity treatment on children with hemiplegic cerebral palsy: a preliminary study. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:453-61. [PMID: 23857615 DOI: 10.1590/0004-282x20130061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 03/04/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare motor and functional performance of two groups of children with hemiplegic cerebral palsy (HCP). Only the study group (SG) received early treatment of spasticity with botulinum neurotoxin type A (BXT-A). METHODS Gross Motor Function Measure (GMFM), functional performance (Pediatric Evaluation of Disability Inventory - PEDI), range of movement, gait pattern (Physician Rating Scale - PRS) and the speed of hand movements were considered. RESULTS The SG, composed of 11 HCP (45.64±6.3 months), was assessed in relation to the comparison group, composed of 13 HCP (45.92±6.4 months). SG showed higher scores in four of the five GMFM dimensions, which included scores that were statistically significant for dimension B, and higher scores in five of the six areas evaluated in the PEDI. Active wrist extension, the speed of hand movements and PRS score were higher in the SG. CONCLUSION Children who received early BXT-A treatment for spasticity showed higher scores in motor and functional performance.
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Affiliation(s)
- Marise Bueno Zonta
- Neuropediatrics Center, Clinics Hospital, Universidade Federal do Paraná (UFPR), Curitiba PR, Brazil.
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Efficacy and safety of serial injections of botulinum toxin A in children with spastic cerebral palsy. World J Pediatr 2013; 9:342-5. [PMID: 24235067 DOI: 10.1007/s12519-013-0442-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 10/17/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND Botulinum toxin A (BTX-A) has been successfully used as a treatment for children with spastic cerebral palsy; however, the effect of BTX-A on reducing spasticity only lasts a few months, thus serial injections are required. The present study was to evaluate the efficacy and safety of serial injections of BTX-A in children with spastic cerebral palsy. METHODS Fifty-two pediatric patients with spastic cerebral palsy, 2-12 years of age (mean age, 4.79 ± 2.70), were retrospectively analyzed. Muscle tone was assessed with the Modified Ashworth Scale, and gait was assessed with the Physician Rating Scale. Assessments were undertaken at baseline, 3 months, and 6 months after serial injections of BTX-A. RESULTS The beneficial effects of BTX-A occurred 1 week after the injection, whereas the adverse side-effects appeared within 1 week and lasted <2 weeks. BTX-A significantly improved muscle tone and gait 3 and 6 months after its serial injections compared to baseline (P <0.05). CONCLUSIONS Serial injections of BTX-A are effective and safe for children with spastic cerebral palsy. The sideeffects of serial injections of BTX-A are mild and selflimited.
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The effects of electrical stimulation exercise on muscles injected with botulinum toxin type-A (botox). J Biomech 2012; 46:36-42. [PMID: 23122225 DOI: 10.1016/j.jbiomech.2012.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 08/03/2012] [Accepted: 09/29/2012] [Indexed: 11/23/2022]
Abstract
Botulinum toxin type A (BTX-A) is a frequently used treatment modality for a variety of neuromuscular disorders. It acts by preventing acetylcholine release at the motor nerve endings, inducing muscle paralysis. Although considered safe, studies suggest that BTX-A injections create adverse effects on target and non-target muscles. We speculate that these adverse effects are reduced by direct electrical stimulation (ES) exercising of muscles. The aims were to determine the effects of ES exercise on strength, mass, and contractile material in BTX-A injected muscles, and to investigate if BTX-A injections affect non-target muscles. Seventeen New Zealand White (NZW) rabbits were divided into three groups: (1) Control group received saline injections; (2) BTX-A group received monthly BTX-A (3.5 U/kg) injections into the quadriceps for six months and (3) BTX-A+ES group received monthly BTX-A injections and ES exercise three times a week for six months. Outcome measures included knee extensor torque, muscle mass, and contractile material percentage area in injected and contralateral, non-injected quadriceps. Glycogen depletion and direct muscle stimulation were used to assess possible muscle inhibition in non-injected quadriceps. ES exercise partially prevented muscle weakness, atrophy, and contractile material loss in injected muscles, and mostly prevented muscle degeneration in contralateral, non-injected muscles. Non-injected muscles of BTX-A+ES group showed higher force with direct muscle compared to nerve stimulation, and retained glycogen following the depletion protocol, suggesting that BTX-A inhibited activation in non-target muscles. We conclude that ES exercise provides some protection from degeneration to target and non-target muscles during BTX-A treatments.
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Kaki AM, Arab AA. The use of botulinum toxin and epidural analgesia for the treatment of spasticity and pain in a patient with maple syrup urine disease. Saudi J Anaesth 2012; 6:175-7. [PMID: 22754448 PMCID: PMC3385264 DOI: 10.4103/1658-354x.97035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 7-year-old boy, weighing 18 kg, was diagnosed with maple syrup urine disease (MSUD). He suffered from spasticity of the lower limbs and pain that did not respond to oral medications. Injections of botulinum toxin A (BTX-A) at 10 sites and epidural analgesia with 0.125% bupivacaine were used to treat spasticity with good results. We conclude that BTX-A combined with epidural analgesia may be a useful treatment option for incapacitating, painful spasticity related to MSUD. This treatment modality allowed a comprehensive rehabilitation program to be completed and it lasted longer than 9 months.
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Affiliation(s)
- Abdullah M Kaki
- Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Papavasiliou AS, Nikaina I, Bouros P, Rizou I, Filiopoulos C. Botulinum toxin treatment in upper limb spasticity: treatment consistency. Eur J Paediatr Neurol 2012; 16:237-42. [PMID: 21862370 DOI: 10.1016/j.ejpn.2011.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 07/08/2011] [Accepted: 07/19/2011] [Indexed: 02/04/2023]
Abstract
This study assessed treatment consistency of botulinum toxin administration in spastic upper limbs under pragmatic conditions, as derived through stability of dosages and between injections intervals. Over a period of 8 years, 153 children (81 with bilateral spastic cerebral palsy, 72 with unilateral) were treated according to accepted, experience-based guidelines with Botox and Dysport. Treatment response was based on assessment of spasticity and attainment of pre-determined goals at 3, 6 and 12 months post each treatment. Mean age at treatment onset was 6y 4mo (SD: 4y 10mo), median F/U, 2.5 years (4 months-6 8/12 years). Number of injection sessions was 1-10; few had more than 6 sessions. In 106 (69.28%) children, more than one anatomic regions of the limb were injected. Most (56.2%), had at least two injection sessions; median time interval between the sessions was 9 months (IQR: 4-35 months, similar for unilateral and bilateral cerebral palsy, p = 0.874). Children >4 years old at the first treatment had longer intervals between sessions (25.8%) compared to younger ones (p = 0.010). The mixed effects models demonstrated that botulinum toxin dosage was stable over subsequent visits (p = 0.144) and that intermediate intervals for subsequent visits were similar to the first one (p = 0.279).
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Affiliation(s)
- Antigone S Papavasiliou
- Department of Neurology, Pendeli Children's Hospital, 8 Hippocrates street, Palia Pendeli, 15236 Athens, Greece.
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Botulinum toxin type A treatment in children with cerebral palsy: evaluation of treatment success or failure by means of goal attainment scaling. Eur J Paediatr Neurol 2012; 16:229-36. [PMID: 21843959 DOI: 10.1016/j.ejpn.2010.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 09/17/2010] [Accepted: 09/27/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is considerable variability in the amount of response to BTX-A treatment between and within patients with cerebral palsy (CP). AIMS The purpose of this retrospective cohort study was to evaluate the clinical responsiveness of Botulinum toxin type A (BTX-A) treatment in children with CP and specifically delineate features of treatment success and failure. METHODS Four hundred and thirty-eight children (251 boys, 187 girls; mean age 8 years 2 months, SD 4 years) were included into the study. Goal Attainment Scaling (GAS) was used to classify and evaluate treatment efficacy. Two study groups were defined: one group with an excellent response (GAS≥60.0) and one group with a lack of response (GAS≤40.0) to BTX-A. RESULTS Seventy-five patients (17.1%) had an excellent response and treatment was found to be unsuccessful for 31 patients (7.1%). Children with a lack of response to BTX-A were significantly older compared to children with a high responsiveness (p=0.0013). In the latter group, more children received multi-level injections and fewer children had injections in proximal parts of the lower limb compared to the low responsiveness group (p=0.0024). Moreover, there was a significant difference in the use of different types of casts between both study groups (p=0.0263). CONCLUSION Age, level of treatment and casting seem to be crucial features of BTX-A treatment success or failure in children with CP.
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Desloovere K, De Cat J, Molenaers G, Franki I, Himpens E, Van Waelvelde H, Fagard K, Van den Broeck C. The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy. Eur J Paediatr Neurol 2012; 16:20-8. [PMID: 21945796 DOI: 10.1016/j.ejpn.2011.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 08/04/2011] [Accepted: 08/28/2011] [Indexed: 10/17/2022]
Abstract
AIM To distinguish the effects of different physiotherapeutic programs in a post BTX-A regime for children with Cerebral Palsy (CP). DESIGN Retrospective, controlled intervention study. PARTICIPANTS AND INTERVENTIONS A group of 38 children (X¯ = 7y7m, GMFCS I-III, 27 bilateral, 11 unilateral CP) receiving an individually defined Neurodevelopment Treatment (NDT) program, was matched and compared to a group of children with the same age, GMFCS and diagnosis, receiving more conventional physiotherapy treatment. All patients received selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up treatment, including physiotherapy. OUTCOME MEASURES Three-dimensional gait analyses and clinical examination was performed pre and two months post-injection. Treatment success was defined using the Goal Attainment Scale (GAS). RESULTS Both groups' mean converted GAS scores were above 50. The average converted GAS score was higher in the group of children receiving NDT than in the group receiving conventional physiotherapy (p < 0.05). In the NDT group, overall treatment success was achieved in 76% of the goals, compared to 67% of the goals defined for the conventional physiotherapy group. Especially for the goals based on gait analyses (p < 0.05) and in the group of children with bilateral CP (p < 0.05), treatment success was higher in the NDT group. CONCLUSION In a post-BTX-A regime, the short-term effects of an NDT approach are more pronouncedthan these from a conventional physiotherapy approach.
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Affiliation(s)
- K Desloovere
- Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
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Jazayeri SM, Ashraf A, Fini HM, Karimian H, Nasab MV. Efficacy of botulinum toxin type a for treating chronic low back pain. Anesth Pain Med 2011; 1:77-80. [PMID: 25729661 PMCID: PMC4335729 DOI: 10.5812/kowsar.22287523.1845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Low back pain is a major cause of disability and can result in substantial morbidity and high healthcare costs. Botulinum toxin has been used successfully to alleviate pain for a number of conditions caused by muscle contractions or spasms. OBJECTIVES The aim of this study was to investigate the efficacy of botulinum toxin type A (BoNT-A; Dysport®, Ipsen, UK) for treating chronic low back pain (CLBP). PATIENTS AND METHODS This was a single-blind, randomized clinical trial study. Fifty patients with CLBP received either BoNT-A (40 Ipsen units per injection) or saline in 5 sites in the paraspinal muscles (n = 25 per group). A visual analogue system (VAS) was used to measure pain levels at baseline and at 4 and 8 weeks post-injection. Disability was assessed using the Oswestry low back pain disability questionnaire at baseline and at 8 weeks post-injection. RESULTS After 4 weeks, 76% of patients in the BoNT-A group reported pain relief compared to 20% in the saline group (P < 0. 005). Additionally, greater pain relief was experienced by patients in the BoNT-A group at 8 weeks (64% vs. 12%; P < 0. 001). By week 8, significant functional improvement (a minimum two-grade improvement between baseline and post-treatment assessments) was demonstrated in a higher number of patients receiving BoNT-A than in the saline group (68% vs. 12% , respectively; P < 0. 005). Patients experienced only minor side effects. CONCLUSIONS BoNT-A improves CLBP with a low incidence of side effects and can be used as a therapeutic tool in the management of these patients.
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Affiliation(s)
- Seyed M. Jazayeri
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Ashraf
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Habib M. Fini
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hajar Karimian
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author: Hajar Karimian, Department of Physical Medicine and Rehabilitation, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand St., Shiraz, Iran. Tel.: +98-7112319040, Fax: +98-7112319040, E-mail:
| | - Mohamadreza V. Nasab
- Department of Physical Medicine and Rehabilitation, Shahid Sadughi University of Medical Sciences, Yazd, Iran
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Brochard S, Blajan V, Lempereur M, Garlantezec R, Houx L, Le Moine P, Peudenier S, Lefranc J, Rémy-Néris O. Determining the technical and clinical factors associated with pain for children undergoing botulinum toxin injections under nitrous oxide and anesthetic cream. Eur J Paediatr Neurol 2011; 15:310-5. [PMID: 21273098 DOI: 10.1016/j.ejpn.2010.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 12/24/2010] [Accepted: 12/31/2010] [Indexed: 11/29/2022]
Abstract
AIMS To determine technical and clinical factors associated with pain when using an analgesic protocol with 50% nitrous oxide/oxygen and anesthetic cream (lidocaine and prilocaine, Emla(®)) for children with cerebral palsy undergoing botulinum toxin injections. METHODS Monocentric prospective study including 50 children newly injected with a mean age of 6.6 years (± 4.32, range 1-18) and 199 injected muscles. Pain was evaluated using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The following variables were noted: gender, age, weight, Gross Motor Function Classification System, type of cerebral palsy (hemiplegic, diplegic, tetraplegic), muscles injected and severe cognitive impairment. The procedure was broken down into three phases for the purpose of pain evaluation: puncture, muscle localization using electrostimulation and injection of botulinum toxin. RESULTS The mean CHEOPS score was 8.16 (± 3.5) and 38% of scores were above the therapeutic threshold of 9. The injection phase was significantly more painful (6.77 ± 3.30) than the puncture (4.88 ± 2.03) and localization (5.46 ± 2.68) phases. The adductor muscles were less painful than other muscles. Children with more severe cognitive impairment seemed to perceive higher levels of pain than the others. Other clinical factors were not associated with pain score. CONCLUSION Clinical characteristics seem not strongly correlated to the success or failure of the 50% nitrous oxide/oxygen-Emla(®) protocol and this pain treatment protocol does not prevent equally all phases of botulinum toxin injections. Future research on the products and its dilution might help to reduce pain level.
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Affiliation(s)
- Sylvain Brochard
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Morvan, 5 avenue Foch, 29200 Brest, France.
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Xu WD, Hua XY, Zheng MX, Xu JG, Gu YD. Contralateral C7 nerve root transfer in treatment of cerebral palsy in a child: Case report. Microsurgery 2011; 31:404-8. [DOI: 10.1002/micr.20877] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 12/03/2010] [Indexed: 11/06/2022]
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Balbaloglu O, Basaran A, Ayoglu H. Functional outcomes of multilevel botulinum toxin and comprehensive rehabilitation in cerebral palsy. J Child Neurol 2011; 26:482-7. [PMID: 21270468 DOI: 10.1177/0883073810384868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to measure the effect of lower extremity multilevel botulinum toxin A injections and comprehensive rehabilitation on spasticity and to determine the functional gains in ambulatory children with cerebral palsy. Sixteen ambulatory children with spastic cerebral palsy (9 hemiplegic, 7 diplegic), aged between 3 and 8 years, who were able to walk with or without assistance (Gross Motor Functional Classification System I-III) were recruited to the study. Botulinum toxin A injections were applied to a total of 23 extremities, followed by a comprehensive rehabilitation program. Walking distance and walking speed (evaluated by the Six-Minute Walk Test) were significantly improved after treatment. Similarly, scores on the Observational Gait Scale (assessed by video gait analysis) increased significantly. Improvements in muscle length, spasticity, and selectivity were recorded. Reduced muscle spasticity after botulinum toxin A injections in children with cerebral palsy, with a comprehensive rehabilitation program, enabled clinically relevant improvements in functional ability.
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Affiliation(s)
- Ozlem Balbaloglu
- Zonguldak Karaelmas University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Zonguldak, Turkey
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Fehlings D, Novak I, Berweck S, Hoare B, Stott NS, Russo RN. Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement. Eur J Neurol 2011; 17 Suppl 2:38-56. [PMID: 20633178 DOI: 10.1111/j.1468-1331.2010.03127.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The primary objective of this paper was to evaluate the published evidence of efficacy and safety of botulinum neurotoxin (BoNT) injections in paediatric upper limb hypertonia (PULH). Secondary objectives included the provision of clinical context, based on evidence and expert opinion, in the areas of assessment, child and muscle selection, dosing, and adjunctive treatment. A multidisciplinary panel of authors systematically reviewed, abstracted, and classified relevant literature. Recommendations were based on the American Academy of Neurology (AAN) evidence classification. Following a literature search, 186 potential articles were screened for inclusion, and 15 of these met the criteria and were reviewed. Grade A evidence was found to support the use of BoNT to reach individualized therapeutic goals for PULH. There is grade B evidence (probably effective) for tone reduction following BoNT injections and grade U evidence (inconclusive) for improvement in upper limb (UL) activity and function. BoNT injections were generally found to be safe and well tolerated with the most common side effect identified as a transient decrease in grip strength.
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Affiliation(s)
- D Fehlings
- Bloorview Research Institute, Bloorview Kids Rehab, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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Teles MS, Mello EMCDL. Toxina botulínica e fisioterapia em crianças com paralisia cerebral espástica: revisão bibliográfica. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000100021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A paralisia cerebral (PC) é definida como uma condição neurológica não progressiva originada em razão de uma lesão no encéfalo imaturo que compromete os movimentos e a postura. A espasticidade está presente em 75% dos casos. Essa patologia tem incidência na população de aproximadamente 2 em cada 1.000 nascidos vivos e pode chegar a até 7 por 1.000 em países em desenvolvimento. O objetivo do estudo foi realizar uma revisão bibliográfica por meio da seleção e análise criteriosa de artigos científicos que relatem os efeitos da aplicação da toxina botulínica tipo A associada à fisioterapia em crianças com paralisia cerebral espástica. MATERIAIS E MÉTODOS: Foi realizada uma revisão bibliográfica nas bases de dados eletrônicas MEDLINE, LILACS e SciELO, no período de 1997 a 2009. Os descritores utilizados foram: "paralisia cerebral" e "espasticidade muscular", combinados com "toxina botulínica tipo A" e "fisioterapia". RESULTADOS: Somando-se todos os bancos de dados, um total de 50 artigos que continham os desfechos de interesse dessa revisão foram encontrados, no entanto, alguns artigos aparecem em mais de uma busca e em duplicidade de idioma. Então, 23 artigos foram utilizados neste estudo. DISCUSSÃO: Vários estudos demonstram que, para maior efetividade da toxina botulínica tipo A, esta deve ser associada a um programa fisioterapêutico que sempre deve considerar as etapas do desenvolvimento motor da criança. CONSIDERAÇÕES FINAIS: De acordo com a revisão bibliográfica apresentada, a TBA associada à fisioterapia para o controle da espasticidade se mostra bastante eficaz. Contudo, novas pesquisas acerca deste assunto são necessárias.
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Placzek R, Siebold D, Funk JF. Development of treatment concepts for the use of botulinum toxin a in children with cerebral palsy. Toxins (Basel) 2010; 2:2258-71. [PMID: 22069684 PMCID: PMC3153296 DOI: 10.3390/toxins2092258] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 08/24/2010] [Accepted: 08/26/2010] [Indexed: 11/16/2022] Open
Abstract
The treatment of children with cerebral palsy with Botulinum toxin A injections is well established, safe and effective. However, a standardized injection strategy is still missing and the used dosage has escalated over the years. In the recent past, the recommended dosages in Europe were, however, reduced due to a better understanding of the relationship between dosage, severe side effects and the kind of anesthesia used. To combine safety and efficacy, the trend tends to a lower dosage, but combined with a more specific selection of injected muscles. The treatment of these key-muscles takes into account the best support for motor development to attain each individual motor milestone.
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Affiliation(s)
- Richard Placzek
- Department of Paediatric Orthopaedics, Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany;
- Author to whom correspondence should be addressed; ; Tel.: +49-0-30-450-652247
| | - Dagmar Siebold
- Centre for physiotherapy and neurorehabilitation, Berlin, Germany;
| | - Julia F. Funk
- Department of Paediatric Orthopaedics, Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany;
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Molenaers G, Van Campenhout A, Fagard K, De Cat J, Desloovere K. The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb. J Child Orthop 2010; 4:183-95. [PMID: 21629371 PMCID: PMC2866843 DOI: 10.1007/s11832-010-0246-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 02/12/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this review is to clarify the role of botulinum toxin serotype A (BTX-A) in the treatment of children with cerebral palsy (CP), with a special focus on the lower limb. BACKGROUND The treatment of spasticity is central in the clinical management of children with CP. BTX-A blocks the release of acetylcholine at the motor end plate, causing a temporary muscular denervation and, in an indirect way, a reduced spasticity. Children with increased tone develop secondary problems over time, such as muscle contractures and bony deformities, which impair their function and which need orthopaedic surgery. However in these younger children, delaying surgery is crucial because the results of early surgical interventions are less predictable and have a higher risk of failure and relapse. As BTX-A treatment reduces tone in a selective way, it allows a better motor control and muscle balance across joints, resulting in an improved range of motion and potential to strengthen antagonist muscles, when started at a young age. The effects are even more obvious when the correct BTX-A application is combined with other conservative therapies, such as physiotherapy, orthotic management and casts. There is now clear evidence that the consequences of persistent increased muscle tone can be limited by applying an integrated multi-level BTX-A treatment approach. Nevertheless, important challenges such as patient selection, defining appropriate individual goals, timing, dosing and dilution, accuracy of injection technique and how to measure outcomes will be questioned. Therefore, "reflection is more important than injection" remains an actual statement.
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Affiliation(s)
- Guy Molenaers
- />Department of Paediatric Orthopaedics, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium
- />Musculoskeletal Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anja Van Campenhout
- />Department of Paediatric Orthopaedics, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium
- />Musculoskeletal Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katrien Fagard
- />Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Pellenberg, Belgium
| | - Jos De Cat
- />Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Pellenberg, Belgium
| | - Kaat Desloovere
- />Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Pellenberg, Belgium
- />Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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[Botulinum toxin A in children with infantile cerebral palsy: indications and treatment concepts]. DER ORTHOPADE 2010; 39:23-30. [PMID: 20033394 DOI: 10.1007/s00132-009-1534-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Botulinum toxin A treatment in children with cerebral palsy is now well established as a safe and effective therapy option. However, a standardised injection strategy is still lacking. There is no doubt concerning the necessity for long-term therapy to cover the duration of motor development as well as for adequate prevention of fixed contractures. The appropriate dose and treatment concept to be used, however, is still controversial. The modern BoNT-A treatment concept must combine safety and efficacy with the availability of this treatment option throughout the duration of growth in these children. Consequently, in order to provide the best possible support for motor development at each individual motor milestone and using moderate dose recommendations, the "Key-Muscle Concept" has been developed.
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Brochard S, Blajan V, Lempereur M, Le Moine P, Peudenier S, Lefranc J, Rémy-Néris O. Effectiveness of nitrous oxide and analgesic cream (lidocaine and prilocaine) for prevention of pain during intramuscular botulinum toxin injections in children. Ann Phys Rehabil Med 2009; 52:704-16. [DOI: 10.1016/j.rehab.2009.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 08/14/2009] [Indexed: 11/25/2022]
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