title: [Infiltration of the psoas muscles with botulinum toxin guided by computerised axial tomography: a series of cases].
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of infiltrating the psoas muscle with botulinum toxin guided by computerised tomography (CT) in order to reduce dynamic contracture in bending the hip.
  
  
  METHODS
  The study involves a series of five children diagnosed with spastic cerebral palsy and bilateral involvement. All the children were able to walk and they presented an attitude on bending the hips and knees consisting in the typical 'crouch gait' together with a dynamic contracture of the hips and knees. They did not present any contraindications for the use of botulinum toxin and their parents gave their consent. Under CT control and anaesthetic sedation, both psoas muscles were infiltrated with a dose of 3 U/kg of body weight; later, both ischiotibial muscles were infiltrated using 3 U/kg doses. The patients were evaluated both prior to and four weeks after infiltration; the muscular range was assessed by means of goniometry, muscular tone was evaluated using the modified Ashworth scale, spasticity was measured using Tardieu's dynamic test and the attitude in bending the hips and knees under a load was assessed by goniometric measurement. Likewise, adverse secondary effects to the puncture or to the use of the toxin were recorded.
  
  
  RESULTS
  The five patients reported an improvement in both mobility (with a reduction of tone and contracture) and the posture when standing.
  
  
  CONCLUSIONS
  Infiltration of the psoas muscle guided by CT is an effective, safe technique for reducing spasticity in bending the hip, which, if accompanied by infiltration of the ischiotibial muscles, improves the attitude on bending the hip and knee.
authors: UGC Rehabilitación, Hospitales Universitarios Virgen del Rocío, Sevilla, España. manuel.rodriguezpinero.sspa@juntadeandalucia.es
authors: Manuel
authors: M
authors: Rodríguez-Piñero Durán
authors: Rocío
authors: R
authors: Martín-Gutiérrez
authors: M Encarnación
authors: ME
authors: Martínez-Sahuquillo Amuedo
authors: M Carmen
authors: MC
authors: Rodríguez-Burgos
authors: Carmen
authors: C
authors: Echevarría-Ruiz de Vargas
mesh_terms: D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000494:pharmacology / Q000627:therapeutic use; D016658:Psoas Muscles / Q000187:drug effects* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A