[Clinical experience of the repeated multilevel injections of the botulinum toxin type A (abobotulinum toxin A) in the spastic forms of cerebral palsy].

Abstract

OBJECTIVE:

Our aim was to analyze the dosages of Abobotulinum toxin A used for each muscle in the clinically effective and safe repeated multilevel injections in CP children, and the intervals between injections.

METHODS:

Retrospective analysis of 229 injection sessions into 359 muscles of the upper and 361 muscles of the lower extremities in 133 children (2-18 years) with spastic CP. Analysis included only patients who were injected for the first time and demonstrated decrease of spasticity in injected muscles according to modified Ashworth and/or Tardieu scales without significant side effects 2-4 weeks after injections. Motor deficit according to GMFCS was: GMFCS I--16(12%) children, GMFCS II--26 (19.6%), GMFCS III--43 (32.3%), GMFCS IV--30 (22.6%), GMFCS V--18 (13.5%). Repeated injections (up to 5 sessions) were done in 59 children. Maximum follow-up perion was 22 months. 40 patients (30.1%) had one-sided injections, 93 (69.9%)--two-sided, 125 (94%)--multilevel injections.

RESULTS:

We presented minimal and maximal dosages, interquartile ranges for each injected muscle, also "off-label" and our proposition of per-segment calculation of dosages in multilevel injections in CR. We also demonstrated the stability of intervals between repeated injections and dosages per kg in a patient. These results are compared with the official Russian and international recommendations of BTX-A treatment for children.

CONCLUSION:

We presented our experience of BTX-A dosages calculation for the spastic CP treatment which could be used as a recommendation and guide for the multilevel injections treatment according to the aims of rehabilitation, spasticity level, muscle size and motor deficit of a concrete patient.

• Authors: O A Klochkova, A L Kurenkov, H M Karimova, L S Namazova-Baranova, A M Memedyarov, L M Kuzenkova, B I Bursagova
• Journal: Vestnik Rossiiskoi akademii meditsinskikh nauk (Vestn Ross Akad Med Nauk) Issue 9-10 Pg. 57-63 ( 2014) ISSN: 0869-6047 [Print] Russia (Federation)
• PMID: 25816644 (Publication Type: Clinical Trial, English Abstract, Journal Article)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A
• abobotulinumtoxinA

Topics

• Adolescent
• Botulinum Toxins, Type A (administration & dosage, therapeutic use)
• Cerebral Palsy (drug therapy)
• Child
• Child, Preschool
• Drug Administration Schedule
• Female
• Humans
• Injections, Intramuscular
• Male
• Muscle Spasticity (drug therapy)
• Neuromuscular Agents (administration & dosage)
• Retrospective Studies
• Treatment Outcome