Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC12110.15690/vramn.v68i11.842PEDIATRICS: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПЕДИАТРИИDEVELOPMENT OF MOTOR FUNCTIONS AND MANUAL ABILITIES IN PEDIATRIC PATIENTS WITH SPASTIC CEREBRAL PALSY AFTER BOTULINUM TOXIN TREATMENT AND COMPLEX REHABILITATIONОБЩЕЕ МОТОРНОЕ РАЗВИТИЕ И ФОРМИРОВАНИЕ ФУНКЦИИ РУК У ПАЦИЕНТОВ СО СПАСТИЧЕСКИМИ ФОРМАМИ ДЕТСКОГО ЦЕРЕБРАЛЬНОГО ПАРАЛИЧА НА ФОНЕ БОТУЛИНОТЕРАПИИ И КОМПЛЕКСНОЙ РЕАБИЛИТАЦИИKlochkovaO. A.КлочковаО. А.
Russian Federation

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

Klochkova_oa@nczd.ruKurenkovA. L.КуренковА. Л.
Russian Federation

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

kurenkov@nczd.ruNamazova-BaranovaL. S.Намазова-БарановаЛ. С.
Russian Federation

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

namazova@nczd.ruMamed'yarovA. M.МамедъяровА. М.
Russian Federation

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

amm@nczd.ruZherdevK. V.ЖердевК. В.
Russian Federation

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

zherdev@nczd.ruScientific Centre of Children Health of RAMS, Moscow, Russian FederarionНаучный центр здоровья детей РАМН, Москва, Российская ФедерацияScientific 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 FederationНаучный центр здоровья детей РАМН, Москва, Российская Федерация Первый Московский государственный медицинский университет им. И.М. Сеченова, Российская Федерация Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, Москва, Российская Федерация121120136811Vestnik Rossiiskoi akademii medetsinskikh nauk / Annals of the Russian academy of medical sciencesВестник Российской академии медицинских наук384807082015Copyright ©; 1970, "Paediatrician" Publishers LLCCopyright ©; 1970, Издательство "Педиатръ"1970"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/article/view/121

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.

Цель исследования: изучить динамику формирования общих моторных функций и функции рук у пациентов со спастическими формами детского церебрального паралича (ДЦП) на фоне комплексной реабилитации, дополненной однократными и повторными инъекциями ботулинического токсина типа А (БТА). Пациенты и методы: в течение 18 месяцев проведено проспективное наблюдение 52 пациентов с одно- и двусторонними спастическими формами детского церебрального паралича на фоне однократных и повторных инъекций БТА и комплексной реабилитации. Всего проведено 74 инъекционные сессии. 17 (32,7%) детей получили двукратные инъекции, 5 (9,6%) — трехкратные. Результаты моторного развития детей оценены с использованием международных шкал GMFCS, GMFMS-88 и центильных таблиц моторного развития, соотнесенных с этими шкалами. Функция рук оценена с применением шкалы MACS. Впервые проведено сопоставление результатов реабилитации с применением ботулотоксина типа А и показателей естественного моторного развития пациентов с различными классами двигательных нарушений при детском церебральном параличе. Результаты: в группе пациентов с двусторонними формами ДЦП улучшения показателей моторного развития происходили медленнее и сохранялись длительнее, по сравнению с пациентами с гемипарезом. Функциональный класс моторики рук по шкале MACS не зависел от гестационного возраста пациентов, был выше у детей с гемипарезом и клинически значимо изменился в 4 (7,7%) случаях после первого курса ботулинотерапии.

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