Clinical Effcacy of Multipoint Injection of Botulinum Toxin in the Treatment of Spastic Cerebral Palsy in Children_West China Medical Journal

Authors：

 LEICong-jie ¹ , ZHONGHui ¹ , ZHANGHong ¹ ,  HECheng-qi ²

1. Department of Rehabilitation, Zigong Hospital of Traditional Chinese Medicine, Zigong, Sichuan 643000, P. R. China;
2. Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HECheng-qi, Email: hechqi@yahoo.com.cn

Keywords：

Botulinum toxin; Cerebral palsy; Target muscle injection; Multilevel model

DOI：

10.7507/1002-0179.20150356

Video：

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Objective To observe whether multipoint target muscle injection of botulinum toxin type A (BTX-A) in the treatment of spastic cerebral palsy in children is better than non-multipoint target muscle injection. Methods From February to October 2013, 42 children with spastic cerebral palsy were treated in our hospital. According to the treatment sequence, the children were numbered. Those with an odd number were designated into multipoint target muscle injection group (group A), and those with an even number were put into non-multipoint target muscle ordinary injection group (group B). Each group had 21 children, and all of them were treated with the injection of BTX-A. Modified Ashworth Scoring (MAS) was performed for all the children before treatment, and 2 weeks, one month, and three months after treatment. The change of dorsiflexion range of motion with knee flexion and extension was recorded and compared. The analysis was done by using multilevel statistical method. Results Both groups of children had significantly improved their ankle range and modified Ashworth score (P<0.05). No interaction between measurement time and group was detected, and the differences between the two groups had no statistical significance (P>0.05). Conclusion Lower muscle tone, greater ankle mobility and better motor function can be achieved after Botulinum toxin A treatment. For now, we cannot draw the conclusion that the effect of multipoint target muscle injection is better than that of non-multipoint target muscle injection in the treatment of spastic cerebral palsy in children.

Citation： LEICong-jie, ZHONGHui, ZHANGHong, HECheng-qi. Clinical Effcacy of Multipoint Injection of Botulinum Toxin in the Treatment of Spastic Cerebral Palsy in Children. West China Medical Journal, 2015, 30(7): 1239-1242. doi: 10.7507/1002-0179.20150356 Copy

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7.	中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑瘫康复专业委员会. 小儿脑性瘫痪的定义、分型和诊断条件[J]. 中华物理医学与康复杂志, 2007, 29(5):305-309.
8.	窦祖林. 痉挛-评估与治疗[M]. 北京:人民卫生出版社, 2004:296-306.
9.	刘建军, 纪树荣, 胡莹媛, 等. A型肉毒毒素缓解脑瘫痉挛的适宜剂量与相关因素的研究[J]. 中国康复理论与实践, 2008, 14(4):358-360.
10.	Galli M, Cimolin V, Valente EM, et al. Computerized gait analysis of botulinum toxin treatment in children with cerebral palsy[J]. Disabil Rehabil, 2007, 29(8):659-664.
11.	罗蓉, 毛萌. 肉毒毒素在脑性瘫痪康复中的应用[J]. 实用儿科临床杂志, 2005, 20(6):594-596.
12.	Sätilä H, Pietikäinen T, Iisalo T, et al. Botulinum to xin type A injections into the calf muscles for treatment of spastic equinus in cerebral palsy:a randomized trial comparing single and multiple injection sites[J]. Am J Phys Med Rehabil, 2008, 87(5):386-394.
13.	林波, 谢鸿翔, 刘楠, 等. 肉毒素治疗脑瘫患儿小腿三头肌痉挛的疗效观察[J]. 中国康复, 2013, 28(5):370-371.
14.	张艳芝, 郝青英. 肉毒毒素结合康复训练对痉挛性脑瘫患者疗效的Meta分析[J]. 中国医疗前沿:上半月, 2011, 6(3):15-16.
15.	Jianjun L, Shurong J, Weihong W, et al. Botulinum toxin-A with and without rehabilitation for the treatment of spastic cerebral palsy[J]. J Int Med Res, 2013, 41(3):636-641.
16.	Barber L, Hastings-Ison T, Baker R, et al. The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy:a 12-month prospective study[J]. J Child Orthop, 2013, 7(5):425-433.
17.	Bjornson K, Hays R, Graubert C, et al. Botulinum toxin for spasticity in children with cerebral palsy:a comprehensive evaluation[J]. Pediatrics, 2007, 120(1):49-58.

1. 李晓捷. 实用小儿脑性瘫痪康复治疗技术[M]. 北京:人民卫生出版社, 2009:3-7.
2. 王志娇, 肖农. 肉毒毒素在脑性瘫痪儿童治疗中的应用进展[J]. 中华物理医学与康复杂志, 2010, 32(5):397-399.
3. Goldstein M, Harper DC. Management of cerebral palsy:equinus gait[J]. Dev Med Child Neurol, 2001, 43(8):563-569.
4. Papadonikolakis AS, Vekris MD, Korompilias AV, et al. Botulinum a toxin for treatment of lower limb spasticity in cerebral palsy:gait analysis in 49 patients[J]. Acta Orthop Scand, 2003, 74(6):749-755.
5. Willis AW, Crowner B, Brunstrom JE, et al. High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy[J]. Dev Med Child Neurol, 2007, 49(11):818-822.
6. 中国康复医学会. 肉毒毒素治疗成人肢体肌痉挛中国指南 (2010)[J]. 中国康复医学杂志, 2010, 25(6):595-620.
7. 中国康复医学会儿童康复专业委员会, 中国残疾人康复协会小儿脑瘫康复专业委员会. 小儿脑性瘫痪的定义、分型和诊断条件[J]. 中华物理医学与康复杂志, 2007, 29(5):305-309.
8. 窦祖林. 痉挛-评估与治疗[M]. 北京:人民卫生出版社, 2004:296-306.
9. 刘建军, 纪树荣, 胡莹媛, 等. A型肉毒毒素缓解脑瘫痉挛的适宜剂量与相关因素的研究[J]. 中国康复理论与实践, 2008, 14(4):358-360.
10. Galli M, Cimolin V, Valente EM, et al. Computerized gait analysis of botulinum toxin treatment in children with cerebral palsy[J]. Disabil Rehabil, 2007, 29(8):659-664.
11. 罗蓉, 毛萌. 肉毒毒素在脑性瘫痪康复中的应用[J]. 实用儿科临床杂志, 2005, 20(6):594-596.
12. Sätilä H, Pietikäinen T, Iisalo T, et al. Botulinum to xin type A injections into the calf muscles for treatment of spastic equinus in cerebral palsy:a randomized trial comparing single and multiple injection sites[J]. Am J Phys Med Rehabil, 2008, 87(5):386-394.
13. 林波, 谢鸿翔, 刘楠, 等. 肉毒素治疗脑瘫患儿小腿三头肌痉挛的疗效观察[J]. 中国康复, 2013, 28(5):370-371.
14. 张艳芝, 郝青英. 肉毒毒素结合康复训练对痉挛性脑瘫患者疗效的Meta分析[J]. 中国医疗前沿:上半月, 2011, 6(3):15-16.
15. Jianjun L, Shurong J, Weihong W, et al. Botulinum toxin-A with and without rehabilitation for the treatment of spastic cerebral palsy[J]. J Int Med Res, 2013, 41(3):636-641.
16. Barber L, Hastings-Ison T, Baker R, et al. The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy:a 12-month prospective study[J]. J Child Orthop, 2013, 7(5):425-433.
17. Bjornson K, Hays R, Graubert C, et al. Botulinum toxin for spasticity in children with cerebral palsy:a comprehensive evaluation[J]. Pediatrics, 2007, 120(1):49-58.

West China Medical Journal

Clinical Effcacy of Multipoint Injection of Botulinum Toxin in the Treatment of Spastic Cerebral Palsy in Children

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