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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6.	中國康復醫學會. 肉毒毒素治療成人肢體肌痙攣中國指南 (2010)[J]. 中國康復醫學雜志, 2010, 25(6):595-620.
7.	中國康復醫學會兒童康復專業委員會, 中國殘疾人康復協會小兒腦癱康復專業委員會. 小兒腦性癱瘓的定義、分型和診斷條件[J]. 中華物理醫學與康復雜志, 2007, 29(5):305-309.
8.	竇祖林. 痙攣-評估與治療[M]. 北京:人民衛生出版社, 2004:296-306.
9.	劉建軍, 紀樹榮, 胡瑩媛, 等. A型肉毒毒素緩解腦癱痙攣的適宜劑量與相關因素的研究[J]. 中國康復理論與實踐, 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.	羅蓉, 毛萌. 肉毒毒素在腦性癱瘓康復中的應用[J]. 實用兒科臨床雜志, 2005, 20(6):594-596.
12.	S?til? H, Pietik?inen 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, 謝鴻翔, 劉楠, 等. 肉毒素治療腦癱患兒小腿三頭肌痙攣的療效觀察[J]. 中國康復, 2013, 28(5):370-371.
14.	張艷芝, 郝青英. 肉毒毒素結合康復訓練對痙攣性腦癱患者療效的Meta分析[J]. 中國醫療前沿: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. 李曉捷. 實用小兒腦性癱瘓康復治療技術[M]. 北京:人民衛生出版社, 2009:3-7.
2. 王志嬌, 肖農. 肉毒毒素在腦性癱瘓兒童治療中的應用進展[J]. 中華物理醫學與康復雜志, 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. 中國康復醫學會. 肉毒毒素治療成人肢體肌痙攣中國指南 (2010)[J]. 中國康復醫學雜志, 2010, 25(6):595-620.
7. 中國康復醫學會兒童康復專業委員會, 中國殘疾人康復協會小兒腦癱康復專業委員會. 小兒腦性癱瘓的定義、分型和診斷條件[J]. 中華物理醫學與康復雜志, 2007, 29(5):305-309.
8. 竇祖林. 痙攣-評估與治療[M]. 北京:人民衛生出版社, 2004:296-306.
9. 劉建軍, 紀樹榮, 胡瑩媛, 等. A型肉毒毒素緩解腦癱痙攣的適宜劑量與相關因素的研究[J]. 中國康復理論與實踐, 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. 羅蓉, 毛萌. 肉毒毒素在腦性癱瘓康復中的應用[J]. 實用兒科臨床雜志, 2005, 20(6):594-596.
12. S?til? H, Pietik?inen 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, 謝鴻翔, 劉楠, 等. 肉毒素治療腦癱患兒小腿三頭肌痙攣的療效觀察[J]. 中國康復, 2013, 28(5):370-371.
14. 張艷芝, 郝青英. 肉毒毒素結合康復訓練對痙攣性腦癱患者療效的Meta分析[J]. 中國醫療前沿: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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