[Botulinum toxin type A in the treatment plan for cerebral palsy].
Over the past decade a number of placebo-controlled studies have confirmed that intramuscular injections of botulinum toxin A (BTX A) has antispastic effects. Cerebral palsy is among the most frequent disorders of the growing locomotor apparatus during childhood. Weakness as well as spasticity due to lack of selective neuronal control causes functional impairment and additional mechanisms of compensation, retardation of motor development, secondary deformities of muscles and soft tissues due to a failure of muscle growth, subluxation/dislocation of joints, early osteoarthritis, and pain. Prevention of this vicious circle has to be the main goal of caring for children with spasticity. Quality of life in children with cerebral palsy can be improved by support of their daily living motor activities. Increased muscle tone can be reduced by physical exercises, by individually adapted orthoses, walkers, and wheelchairs, by manual therapy, serial casting and in certain cases by systemic drugs or by multiple-stage surgical procedures. BTX A can be used to enable these treatment possibilities or to increase their effect. In our clinical study (BTX A in 114 patients in 19952/2000) we found no major side effects. Weakness, pain or swelling occurred temporarily. Indications for the use of BTX A are pain, functional impairment, severe cosmetic problems, as well as prevention of secondary contractures, deformities, and dislocations caused by increased muscle tone. We consider the selection of patients for the use of BTX A and the development of a goal-orientated treatment plan by multidisciplinary team approach as the most important steps. Prerequisites are exact statomotoric and dynamic physical examinations, and standardised movement analysis. 3-D-gait analysis and dynamic electromyography is used in cases where functional improvement of gait is the goal of BTX A-treatment.
Strobl
W
W
Zentrums für Neuroorthopädie, Abteilung für Kinderorthopädie Wien-Speising, Wien, Osterreich. wstrobl@compuserve.com
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D002648:Child; D005684:Gait; D006801:Humans; D007273:Injections, Intramuscular; D008137:Longitudinal Studies; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; D005680:gamma-Aminobutyric Acid; D019274:Botulinum Toxins, Type A; D001418:Baclofen