Use of botulinum toxin A in management of children with cerebral palsy.

BC Children's Hospital, Department of Pediatrics, Vancouver, BC V6H 3V4, Canada.
Canadian family physician Medecin de famille canadien (Impact Factor: 1.19). 09/2011; 57(9):1006-73.
Source: PubMed

ABSTRACT QUESTION: What is the role of intramuscular botulinum toxin injections in the management of spasticity and related morbidity in children with cerebral palsy? ANSWER: When botulinum toxin A is injected into the limbs of children with spastic paresis, it induces temporary reduction in muscle tone. It also promotes better motor function when used in combination with conservative treatments such as physiotherapy. Although there is a growing body of evidence for its effective and safe treatment, there is still a lack of consensus on dose, treatment regimens, and the best integration with other clinical modalities.

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    ABSTRACT: Botulinum toxin A (BTX-A) has been successfully used as a treatment for children with spastic cerebral palsy; however, the effect of BTX-A on reducing spasticity only lasts a few months, thus serial injections are required. The present study was to evaluate the efficacy and safety of serial injections of BTX-A in children with spastic cerebral palsy. Fifty-two pediatric patients with spastic cerebral palsy, 2-12 years of age (mean age, 4.79±2.70), were retrospectively analyzed. Muscle tone was assessed with the Modified Ashworth Scale, and gait was assessed with the Physician Rating Scale. Assessments were undertaken at baseline, 3 months, and 6 months after serial injections of BTX-A. The beneficial effects of BTX-A occurred 1 week after the injection, whereas the adverse side-effects appeared within 1 week and lasted <2 weeks. BTX-A significantly improved muscle tone and gait 3 and 6 months after its serial injections compared to baseline (P <0.05). Serial injections of BTX-A are effective and safe for children with spastic cerebral palsy. The sideeffects of serial injections of BTX-A are mild and selflimited.
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    ABSTRACT: Paralysis of the masticatory muscles using botulinum toxin (BTX) is a common treatment for cosmetic reduction of the masseters as well as for conditions involving muscle spasm and pain. The effects of this treatment on mastication have not been evaluated, and claims that the treatment unloads the jaw joint and mandible have not been validated. If BTX treatment does decrease mandibular loading, osteopenia might ensue as an adverse result. Rabbits received a single dose of BTX or saline into one randomly chosen masseter muscle and were followed for 4 or 12 weeks. Masticatory muscle activity was assessed weekly, and incisor bite force elicited by stimulation of each masseter was measured periodically. At the endpoint, strain gages were installed on the neck of the mandibular condyle and on the molar area of the mandible for in vivo bone strain recording during mastication and muscle stimulation. After termination, muscles were weighed and mandibular segments were scanned with micro CT. BTX paralysis of one masseter did not alter chewing side or rate, in part because of compensation by the medial pterygoid muscle. Masseter-induced bite force was dramatically decreased. Analysis of bone strain data suggested that at 4 weeks, the mandibular condyle of the BTX-injected side was underloaded, as were both sides of the molar area. Bone quantity and quality were severely decreased specifically at these underloaded locations, especially the injection-side condylar head. At 12 weeks, most functional parameters were near their pre-injection levels, but the injected masseter still exhibited atrophy and percent bone area was still low in the condylar head. In conclusion, although the performance of mastication was only minimally harmed by BTX paralysis of the masseter, the resulting underloading was sufficient to cause notable and persistent bone loss, particularly at the temporomandibular joint.
    Bone 12/2011; 50(3):651-62. · 3.82 Impact Factor


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