title: [Initial efficacy of intramuscular injection of botulinum toxin type A against cervical dystonia and general muscular hypertonia in persons with severe motor and intellectual disabilities].
abstract: We introduced an intramuscular injection of botulinum toxin type A (hereafter, BTX-A) in 5 cases of cervical dystonia (CD) with generalized muscular hypertonia (GMH). The patients all had severe motor and intellectual disabilities (SMID). The initial injections (first and second) of BTX-A exerted a focal muscular relaxant effect in all 5 cases. It is interesting that they decreased hypertonia in the lower extremities, which resulted in an improved activity of daily living (ADL) in 4 cases (80%). This fact reveals the involvement of many muscles in regard to CD and GMH, especially in patients with severe cerebral palsy. As for adverse effects, a mild increase of saliva and cough indicated transient misswallowing in 2 cases (40%) and changes in the pattern of head movement and posture in 2 cases (40%). These effects were all mild and did not disturb ADL in any patient. BTX-A is considered to be safer and worthier of trying to decrease complaints related to CD and GMH than we expected. Furthermore, a modified Tsui's score cannot explain the many benefits from BTX-A in the treatment of SMID. For a reliable assessment of BTX-A therapy used to treat CD and GMH, especially in persons with SMID, more expressible and specific assessment methods will need to be established.
authors.affiliation: Department of Pediatrics and Rehabilitation, Kobe Medical Center for Persons with Severe Motor and Intellectual Disabilities, Kobe, Hyogo. ama-p@rc4.so-net.ne.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Adachi
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Saura
mesh_terms: D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D004421:Dystonia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009122:Muscle Hypertonia / Q000188:drug therapy*; D009334:Neck Muscles; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D019989:Persons with Intellectual Disabilities
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A