| Objiectives:To study the value and to observe clinically the indications,sideeffects, dosage, injection technology and effect evaluation with regard to botulium toxin A(BTX-A) in the treatment of children with spastic cerebral palsy. Methods:From January 2003 to August 2006, a total of 61 children with spastic diplegia were recruited,which must be in the inclusion criteria.These children were classified according to the Gross Motor Function Classification System level and age and then randomly divided into two groups: a treatment group(32) and a control group(29). Among the treatment group 19 were male and 13 were female,the mean age was 4.30 ±1. 21 years. While among the control group, 17 were male and 12 were female,the mean age was 4.23±1.28 years. Children in the treatment group received BTX-A injection. Target muscles were identified using the manual method of "stretching in opposite direction and pressing with fingers". The number of injection sites per muscle and the dosage varied according to the body weight, the degree of spasticity and the bulk of the muscles. Next day after injection , physiotherapy programme was applied.Children in the control group received same physiotherapy programme alone. Outcomes were measured before treatment and at 24h,48h,72h,2week,1,2,3and 4 months post injection. The time course of the response to BTX-A was assessed using measurements of the Modified Ashworth Scale.Motor function was assessed by means of the 88-item Gross Motor Function Measure . Physician Rating Scale was performed to evaluate the posture and the gait.Meanwhile,liver functions were tested before treatment and at 2 week after injection in 15 subjects in the treatment group. Results:Response to injection was confirmed by a decrease in MAS in the treatment group after 72h and very little change in controls. This difference was significant(P<0.01) at 2 weeks after injection .Although the gains of the treatment group in MAS increased after 3 months , the difference between two groups was still significant (P<0.05). The treatment group improved significantly motor function after injection at l,3,and 4months(P<0.05 或 P<0.01).While the control group made gains only after 3 months (P<0.05). The standing function of the treatment group was made significantly greater improvement than controls after lmonth(P<0.05) .After 3 months ,the walking function of the treatment group made same change with controls. The treatment group improved greatly in the posture and gait in PRS at 2 weeks after injection (P<0.05) ,and was significantly superior to the intervention for control group after 1 month (P<0.05) .In the treatment group,there wasn't significant difference in liver and urine function between before and after injection (P > 0.05) . Conclusions:1. We confirmed that BTX-A injection can effectively and quickly reduce spasticity. BTX-A in combination with Wuida techniques,muscle power and motor function training can make significantly greater improvement to childen's motor function and short the period of treatment.2. BTX-A injections revealed fewer clinical side effects and had no adverse effect on liver and urine function in children with cerebral palsy in one injection.3. In this study,the function of BTX-A began to decline in 3 months after injection, but the degree of spasticity was still better than that of before treatment.4. The number of injection sites per muscle and the dosage can be defined by the body weight, the degree of spasticity and the bulk of the muscles.5. As for the effect evaluation with regard to botulium toxin A in the treatment of cerebral palsy , the use of three measures of GMFM,MAS and PRS can totally reflect the change of motor function, degree of spasticity and unusual posture and can improve the reliability of effect evaluation.6. The manual method of "stretching in opposite direction and pressing with fingers" in locating target muscles is convenient and feasible. |
PDF Full Text Request