Botulinum toxin type A chemodenervation treatment in spastic forms of cerebral palsy

Cerebral palsy (CP) is one of the most serious outcomes of the perinatal lesion of central nervous system and the most common reason for neurological disability in children. Being the key cause of pathological dynamic stereotypes that frequently result in pathological posture and contractures, spasticity is critically important for CP. The use of botulinum toxin type A (BTA) in complex treatment 2-6 years old CP patients allows significantly to improve motor abilities, help to change the surgical procedure, delay or even avoid some types of surgery. For elder children the use of BTA allows to improve local motor impairment. The treatment of spasticity in CP with BTA is safe (evidence level A) and highly effective (evidence level A). It leads to the positive change of pathological dynamic stereotype, significantly improves gait, decreases muscle tone with Ashworth and Tardeu scales and rises the gross motor function score. Our own experience of onabotulinumtoxinA treatment as a part of complex therapy in 68 patients with spastic forms of CP demonstrates the significant improvement of motor function, most noticeable in younger patients
(early pre-school age) with GMFS I-III.

1. Stanley F., Blair E., Alberman E. Cerebral Palsies: Epidemiology and Causal Pathways. London: MacKeith Press, 2000.

2. Бадалян Л.О., Журба Л.Т., Тимонин а О.В. Детские цереб ральные параличи. Киев: Здоров'я, 1988. 328 с.

3. Sanger T.D., Delgado M.R., Gaebler-Spir a D. et al. Classification and definition of disorders causing hypertonia in childhood. Pediatrics 2003;111:e89–e97.

4. Семенова К.А. Восстановительное лечение детей с перинатальным поражением нервной системы и детским церебральным параличом. М.: Закон и порядок, 2007. 616 с.

5. Miller G. Cerebral Palsies: An Overview. In: The Cerebral Palsies: causes, consequences, and management. Boston: Butterworth-Heinemann, 1998. P. 1–35.

6. Bax M., Goldstein M., Rosenbaum P. et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005;47(8):571–6.

7. Miller F. Cerebral palsy. New York: Springer Science, 2005. 1055 p.

8. Куренков А.Л. Оценка двигательных нарушений при детском церебральном параличе и других болезнях нервной системы детей. Автореф. дис. ... докт. мед. наук. М., 2005. 46 с.

9. Thickbroom G.W., Byrnes M.L., Arche r S.A. et al. Differences in sensory and motor cortical organization following brain injury early in life. Ann Neurol 2001;49(3):320–7.

10. Staudt M., Braun C., Gerloff C. et al. Developing somatosensory projections bypass periventricular brain lesions. Neurology 2006;67(3):522–5.

11. Krageloh-Mann I., Staudt M. Neurophysiological classification and neuroradiology of cerebral palsy. In: Improving hand function in cerebral palsy: theory, evidence and intervention. Eds. A.C. Eliasson and P.A. Burtner. London: Mac Keith Press, 2008. P. 61–78.

12. Heinen F., Desloovere K., Schroede r A.S. et al. 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.

13. Leonard J., Graham H.K. Treatment of motor disorders in cerebral palsy with botulinum neurotoxin. In book: Botulinum toxin: Therapeutic clinical practice and science (Ed. by J. Jankovic). Philadelphia: aunders Elsevier, 2009. P. 172–191.

14. Артеменко А.Р., Куренков А.Л. Ботулинический токсин: вчера, сегодня, завтра. Нервно-мышечные болезни 2013;2:6–18.

15. Dressler D. Clinical applications of botulinum toxin. Curr Opin Microbiol 2012;15(3):325–36.

16. Куренков А.Л., Артеменко А.Р., Никити н С.С., Орлова О.Р. Современные представления о механизмах действия ботулинического токсина типа А. Врач 2009;7:8–12.

17. Dressler D., Saberi F.A., Barbosa E.R. Botulinum toxin: mechanisms of action. Arq Neuropsiquiatr 2005;63:180–5.

18. Dolly J.O., O’Connell M.A. Neurotherapeutics to inhibit exocytosis from sensory neurons for the control of chronic pain. Curr Opin Pharmacol 2012;12:100–8.

19. Molenaers G., Van Campenhout A., Fagar d K. et al.The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb. J Child Orthop 2010;4(3):183–95.

20. Love S.C., Novak I., Kentish M. et al. Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neur 2010;17 (Suppl. 2):9–37.

21. Palisano R., Rosenbaum P., Walter S. et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39(4):214–23.

22. Куренков А.Л., Кузенкова Л.М., Бурсагов а Б.И. и др. Электромиографические исследования для выработки оптимальной тактики инъекций препарата ботулинического токсина типа А у детей со спастическими формами церебрального паралича. Журн неврол и психиатр 2013;5(2):53–60.

23. Gage J.R., Stout J.L. Gait analysis: kinematics, kinetics, electromyography, oxygen consumption and pedobarography. In: The identification and treatment of gait problems in cerebral palsy (Eds. Gage J.R.,

24. Schwartz M.H., Koop S.E., Novacheck T.F.). London: Mac Keith Press, 2009. P. 260–284.

25. Simpson D.M., Gracies J.M., Graha m H.K. et al. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2008;70(19):1691–8.

26. Delgado M.R., Hirtz D., Aisen M. et al. 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):336–43.

27. Sutherland D.H., Kaufman K.R., Wyatt M.P. et al. Double-blind study of botulinum toxin injections into the gastrocnemius muscle in patients with cerebral palsy. Gait and Posture 1999;10:1–9.

28. Koman L.A., Mooney J.F. 3rd, Smith B.P. et al. Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. BOTOX Study Group. J Pediatr Orthop 2000;20(1):108–15.

29. Love S.C., Valentine J.P., Blair E.M. et al. The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomized controlled trial. Eur J Neurol 2001;8 (Suppl 5):50–8.

30. 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):161–70.

31. Pascual-Pascual S.I., Pascual-Castroviej o I., Ruiz P.J. Treating spastic equinus foot from cerebral palsy with botulinum toxin type A: what factors influence the results?: an analysis of 189 consecutive cases. Am J Phys Med Rehabil 2011;90(7):554–63.

32. Sätilä H., Huhtala H. Botulinum toxin type A injections for treatment of spastic equinus in cerebral palsy: a secondary analysis of factors predictive of favorable response. Am J Phys Med/ Rehabil 2010;89(11):865–72.

33. Koman L.A., Mooney J.F. 3rd, Smith B. et al. Management of cerebral palsy with botulinum-A toxin: preliminary investigation. J Pediatr Orthop 1993;13(4):489–95.

34. Graham H.K., Aoki K.R., Autti-Ramo I. et al. Recommendations for the use of botulinum toxin type A in the management of cerebral palsy. Gait Posture 2000;11:67–79.

35. Heinen F., Molenaers G., Fairhurst C. et al. European consensus table 2006 on botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2006;10(5–6):215–25.

36. Placzek R., Siebold D., Funk J.F. Development of treatment concepts for the use of botulinum toxin A in children with cerebral palsy. Toxins 2010;2:2258–71.

37. 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):386–96.

38. Lee L.R., Chuang Y.C., Yang B.J. et al. Botulinum toxin for lower limb spasticity in children with cerebral palsy: A single-blinded trial comparing dilution techniques. Am J Phys Med Rehabil 2004;83:766–73.

39. Fehlings D., Novak I., Berweck S. et al. Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement. Eur J Neurol 2010;17 (Suppl. 2):38–56.

40. Калинина Л.В., Сологубов Е.Г., Лузинови ч В.М., Дутикова Е.М. Ботокс в комплексном лечении детского церебрального паралича. Журн неврол и психиатр 2000;100(12):60–63.

41. Куренков А.Л., Дутикова Е.М., Никити н С.С., Артеменко А.Р. Коррекция препаратом ботулинического токсина типа А (диспорт) деформаций стоп у детей со спастическими формами детского церебрального паралича. Журн неврол и психиатр 2010;110:6:37–43.

42. Полонская Н.М. Современные подходы, методы и роль ботулинотерапии в комплексной реабилитации больных с детским церебральным параличом. Детская и подростковая реабилитация 2012; Т.1:32–6.

43. Дутикова Е.М., Кенис В.М., Куренко в А.Л. Применение препарата Диспорт (ботулинический токсин типа А) для коррекции динамического эквинуса у детей с ДЦП. Разрешение на применение новой медицинской технологии ФС № 2010/173 от 17 мая 2010 г. М., 2010. 23 с.

44. Сальков В.Н. Применение ботулотоксина А при спастических формах детского церебрального паралича у детей: дис. ... канд.мед.наук. М., 2005.

45. Змановская В.А. Клинические варианты спастических форм детского церебрального паралича и оценка эффективности ботулинотерапии: дис. ... канд.мед. наук. Екатеринбург, 2011. 156 с.