Management of spasticity and dystonia in children with acquired brain injury with rehabilitation and botulinum toxin A.
OBJECTIVE
To investigate the effect of a combination of botulinum toxin A (BTX-A) and rehabilitation on spasticity, pain and motor functioning in children with acquired brain injury (ABI).


METHODS
All children and adolescents with ABI, aged 2-20 years, consecutively treated in the department over a 22-month period, were prospectively followed-up and clinically assessed pre- and post-treatment. They had spasticity and/or dystonia leading to impairment in activities of daily living, orthopaedic deformations and/or pain. Injections were performed using electro-stimulation. Doses of BTX-A (Botox) were administered using recent recommendations.


RESULTS
Twenty-five children (mean age 6.3 years) participated in the study (51 injection sessions). All patients received BTX-A injections, followed with physical and/or occupational therapy. Significant improvement was achieved for spasticity reduction (p < 0.0001), command on antagonist muscles (p = 0.03 for the tibialis anterior) and goniometry assessment (p < 0.05). Pain relief was achieved in patients in a minimally responsive state. Functional goals were achieved, such as improving transfers or gait, grasping and releasing abilities, with significant transfer in activities of daily living (p < 0.0001).


CONCLUSIONS
A combination of BTX-A injection with rehabilitation is an interesting option for treatment of muscle tone disorders in children with ABI.
Guettard
Emilie
E
INR A. Hôpital National de Saint Maurice, Service de rééducation des pathologies neurologiques acquises de l'enfant, Saint Maurice, France.
Roze
Emmanuel
E
Abada
Genevieve
G
Lemesle
Catherine
C
Vidailhet
Marie
M
Laurent-Vannier
Anne
A
Chevignard
Mathilde P
MP
D000203:Activities of Daily Living; D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications* / Q000188:drug therapy / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D004421:Dystonia / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000187:drug effects; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation*; D009788:Occupational Therapy; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D016896:Treatment Outcome; D055815:Young Adult
D019274:Botulinum Toxins, Type A