DEVELOPMENT OF MOTOR FUNCTIONS AND MANUAL ABILITIES IN PEDIATRIC PATIENTS WITH SPASTIC CEREBRAL PALSY AFTER BOTULINUM TOXIN TREATMENT AND COMPLEX REHABILITATION

Cover Page


Cite item

Full Text

Abstract

Aim: to investigate the dynamic of general motor function and manual abilities in children with spastic forms of cerebral palsy (CP) after complex rehabilitation combined with single and repeated injections of botulinum toxin A (BTA). Patients and methods: the article presents 18 month follow-up of 52 patients with mono- and bilateral spastic forms of CP after single and multiple injections of botulinum toxin A and complex rehabilitation/ Patients received totally 74 injection sessions: 17 (32,7%) children — twice, 5 (9,6%) children — three times. Motor development assessment was done according to the GMFCS and GMFMS-88 scales and centile curves of normal motor development connected with these scales, hand function was classified according to the MACS scale. For the first time results of botulinum toxin therapy and rehabilitation were compared with the natural motor development of patients with different levels of motor disturbances according to centile tables. Results: patients with bilateral cerebral palsy improved slowly than hemiparetic and changes lasted for longer period. Level according to the MACS scale didn’t depend on the gestational age of the patients, was higher in children with hemiparesis and changed for 1 level in 4 (7,7%) patients after the first botulinum toxin A injections.

 

About the authors

O. A. Klochkova

Scientific Centre of Children Health of RAMS, Moscow, Russian Federarion

Author for correspondence.
Email: Klochkova_oa@nczd.ru
pediatrician of the Department of Remedial Treatment of Children with Nervous System Diseases of Research Institute of Preventive Pediatrics and Remedial Treatment of FSBI SCCH of RAMS. Address: build. 1, 2, Lomonosov Avenue, Moscow, RF, 119991; tel.: +7 (499) 134-01-69 Russian Federation

A. L. Kurenkov

Scientific Centre of Children Health of RAMS, Moscow, Russian Federarion

Email: kurenkov@nczd.ru
PhD, leading research scientist of the Department of Psychoneurology and psychosomatic pathology of Research Institute of Pediatrics of FSBI SCCH of RAMS. Address: build. 1, 2, Lomonosov Avenue, Moscow, RF, 119991; tel.: +7 (499) 134-04-09 Russian Federation

L. S. Namazova-Baranova

Scientific Centre of Children Health of RAMS, Moscow, Russian Federarion
I.M. Sechenov First Moscow Medical State University, Russian Federation
N.I. Pirogov Russian National Scientific Research Medical University, Moscow, Russian Federation

Email: namazova@nczd.ru
PhD, professor, correspondent member of RAMS, Director of Research Institute of Preventive Pediatrics and Remedial Treatment of FSBI SCCH of RAMS. Address: build. 1, 2, Lomonosov Avenue, Moscow, RF, 119991; tel.: +7 (495) 967-14-14 Russian Federation

A. M. Mamed'yarov

Scientific Centre of Children Health of RAMS, Moscow, Russian Federarion

Email: amm@nczd.ru
MD, Head of the Department of Remedial Treatment of Children with Nervous System Diseases of Research Institute of Preventive Pediatrics and Remedial Treatment of FSBI SCCH of RAMS. Address: build. 1, 2, Lomonosov Avenue, Moscow, RF, 119991; tel.: +7 (499) 134-01-69 Russian Federation

K. V. Zherdev

Scientific Centre of Children Health of RAMS, Moscow, Russian Federarion

Email: zherdev@nczd.ru
MD, Head of the Department of Neuroorthopedics and orthopedics of Research Institute of Pediatrics of FSBI SCCH of RAMS. Address: build. 1, 2, Lomonosov Avenue, Moscow, RF, 119991; tel.: +7 (499) 134-07-63 Russian Federation

References

  1. Semenova K.A. Vosstanovitel'noe lechenie detei s perinatal'nym porazheniem nervnoi sistemy i detskim tserebral'nym paralichom [Remedial Treatment of Children Suffering from Perinatal Affection of Central Nervous System and Cerebral Palsy]. Moscow, Zakon i poryadok, 2007. 616 p.
  2. Kurenkov A.L., Batysheva T.T., Vinogradov A.V., Zyuzyaeva E.K. Spasticity with cerebral palsy: diagnosis and treatment strategies. Zhurn. nevrol. i psikhiatr. = Journal of neuropathology and psychiatry. 2012; 7(2): 24–28.
  3. Hoare B.J., Wallen M.A., Imms C., Villanueva E., Rawicki H.B., Carey L. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE). Cochr. Database Syst. Rev. 2010; 1.
  4. Delgado M.R., Hirtz D., Aisen M., Ashwal S., Fehlings D.L., McLaughlin J., Morrison L.A., Shrader M.W., Tilton A., Vargus-Adams J. Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010; 74 (4): 336–343.
  5. Kurenkov A.L., Nosko A.S., Klochkova O.A., Namazova-Baranova L.S., Kuzenkova L.M., Mamed"yarov A.M., Zykov V.P., Bursagova B.I. Metody otsenki motornogo razvitiya rebenka so spasticheskimi formami DTsP pri vybore myshts-mishenei dlya in"ektsii preparata botulinicheskogo toksina tipa A. Metod. ruk-vo dlya vrachei [Assessment Methods of Motor Development of Children Suffering from Spasmodic Cerebral Palsy under the Choice of Muscles-Targets for Injections of Botulinum A Toxin. Guideline for Pediatricians]. Moscow, 2013. 30 p.
  6. Palisano R., Rosenbaum P., Walter S., Russell D., Wood E., Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev. Med. Child Neurol. 1997; 39 (4): 214–223.
  7. Wood E., Rosenbaum P. The gross motor function classification system for cerebral palsy: a study of reliability and stability over time. Dev. Med. Child Neurol. 2000; 42 (5): 292–296.
  8. Hanna, S.E., Bartlett, D.J., Rivard, L.M., Russell D.J. Reference curves for the Gross Motor Function Measure: Percentiles for clinical description and tracking over time among children with cerebral palsy. Phys. Ther. 2008; 88 (5): 596–607.
  9. Gorter J.W., Rosenbaum P.L., Hanna S.E., Palisano R.J., Bartlett D.J., Russell D.J., Walter S.D., Raina P., Galuppi B.E., Wood E. Limb distribution, motor impairment, and functional classification of cerebral palsy. Dev. Med. Child Neurol. 2004; 46 (7): 461–467.
  10. Himmelmann K., Beckung E., Hagberg G., Uvebrant P. Gross and fine motor function and accompanying impairments in cerebral palsy. Dev. Med. Child Neurol. 2006; 48 (6): 417–423.
  11. Rosenbaum P., Walter S., Hanna S. Palisano R.J., Russell D.J., Raina P., Wood E., Bartlett D.J., Galuppi B.E.. Prognosis for gross motor function in cerebral palsy: Creation of motor development curves. J. Am. Med. Association. 2002; 288 (11): 1357–1363.
  12. Miller F. Cerebral palsy. NY: Springer Science. 2005. 1055 p.
  13. Eliasson A.C., Burtner P. Improving hand function in children with cerebral palsy. 1st edn. Mac. Keith Press. 2008.
  14. Kol'tsova M.M. Dvigatel'naya aktivnost' i razvitie funktsii mozga rebenka (Rol' dvigatel'nogo analizatora v formirovanii vysshei nervnoi deyatel'nosti rebenka) [Motor and Brain Functioning Development of Children (Impact of Motor Analyzer in Development of Neural Activity of Children)]. Moscow, Pedagogika, 1973.
  15. Eliasson A.C., Krumlinde-Sundholm L., Rösblad B., Beckung E., Arner M., Ohrvall A.M., Rosenbaum P. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev. Med. Child Neurol. 2006; 48 (7): 549–554.
  16. Carnahan K.D., Arner M., Hägglund G. Association between gross motor function (GMFCS) and manual ability (MACS) in children with cerebral palsy. A population-based study of 359 children. BMC Muscul. Dis. 2007; 8: 50.
  17. Holmström L., Vollmer B., Tedroff K., Islam M., Persson J.K., Kits A., Forssberg H., Eliasson A.C. Hand function in relation to brain lesions and corticomotor-projection pattern in children with unilateral cerebral palsy Dev. Med. Child Neurol. 2010; 52 (2): 145–152.
  18. Heinen F., Desloovere K., Schroeder A.S., Berweck S., Borggraefe I., van Campenhout A., Andersen G.L., Aydin R., Becher J.G., Bernert G., Caballero I.M., Carr L., Valayer E.C., Desiato M.T., Fairhurst C., Filipetti P., Hassink R.I., Hustedt U., Jozwiak M., Kocer S.I., Kolanowski E., Krägeloh-Mann I., Kutlay S., Mäenpää H., Mall V., McArthur P., Morel E., Papavassiliou A., Pascual-Pascual I., Pedersen S.A., Plasschaert F.S., van der Ploeg I., Remy-Neris O., Renders A., Di Rosa G., Steinlin M., Tedroff K., Valls J.V., Viehweger E., Molenaers G. The updated European Consensus 2009 on the use of botulinum toxin for children with cerebral palsy. Eur. J. Paediatr. Neurol. 2010; 14 (1): 45–66.
  19. Ubhi T., Bhakta B.B., Ives H.L., Allgar V., Roussounis S.H. Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy. Arch. Dis. Child. 2000; 83 (6): 481–487.
  20. Mall V., Heinen F., Siebel A., Bertram C., Hafkemeyer U., Wissel J. Treatment of adductor spasticity with BTX-A in children with CP: a randomized, double-blind, placebocontrolled study. Dev. Med. Child Neurol. 2006; 48 (1): 10–13.
  21. Baker R., Jasinski M., Maciag-Tymecka I., Michalowska-Mrozek J., Bonikowski M., Carr L. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose ranging study. Dev. Med. Child Neurol. 2002; 44 (10): 666–675.
  22. Berweck S., Kirschner J., Heinen F. Therapy with botulinum toxin. In: Paediatric neurology: Theory and practice. C.P. Panteliadis, R. Korinthenberg (eds.). Stuttgart; New York: Thieme. 2005. P. 925–951.
  23. Hägglund G., Andersson S., Düppe H., Lauge-Pedersen H., Nordmark E., Westbom L. Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity. J. Pediatr. Orthop. B. 2005; 14 (4): 269–273.
  24. Molenaers G., Desloovere K., Fabry G., De Cock P. The effects of quantitative gait assessment and botulinum toxin A on musculoskeletal surgery in children with cerebral palsy. J. Bone Joint Surg. Am. 2006; 88 (1): 161–170.
  25. Baranov A.A., Klochkova O.A., Kurenkov A.L., Namazova-Baranova L.S., Nikitin S.S., Artemenko A.R., Mamed"yarov A.M. The role of brain plasticity in the functional adaptation of the organism with cerebral palsy with the defeat of the hands. Pediatrich. farmakol = Pediatric pharmacology. 2012; 9(6): 24–32.
  26. Cosgrove A.P., Corry I.S., Graham H.K. Botulinum toxin in the management of the lower limb in cerebral palsy. Dev. Med. Child Neurol. 1994; 36 (5): 386–396.
  27. Eames N.W.A., Baker R., Hill N., Graham K., Taylor Т., Cosgrove A. The effect of Botulinum toxin A on gastrocnemius length: magnitude and duration of response. Dev. Med. Child Neurol. 1999; 41: 226–232.
  28. Zmanovskaya V.A. Klinicheskie varianty spasticheskikh form detskogo tserebral'nogo paralicha i otsenka effektivnosti botulinoterapii. Avtoref. diss. ... kand. med. nauk [Clinical Classification of Spasmodic Cerebral Palsy and Assessment of Botulinum Therapy’s Effectiveness. Author’s abstract]. Ekaterinburg, 2011. 24 p.
  29. Oeffinger D., Gorton G., Bagley A. Outcome assessment in children with cerebral palsy, Part I: descriptive characteristics of GMFCS Levels I to III. Dev. Med. Child Neurology. 2007, 49: 172–180.
  30. Sheean G., Lannin N.A., Turner-Stokes L. Botulinum toxin assessment, intervention and after-care for upper limb hypertonicity in adults: international consensus statement. Eur. J. Neurol. 2010; 17 (2): 74–93.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 1970 "Paediatrician" Publishers LLC



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies