Laima Mikulėnaitė, Jovita Petrulytė, Anastasija Žernakova


Introduction. Spasticity – the basic and the most commonclinical syndrome of cerebral palsy. Most of the time child’sfunctional and movement disorders depend on this. Botulinumtoxin is a drug that relaxes muscles by blocking the release ofacetylcholine (ACH) in neuro muscular connection and reduceslevel of spasticity. The short-term effect of BTX has been provenin scientific literature and it is well known. The effect of treatmentwith BTX –A in a long-term remains insufficiently studied.Purpose. To evaluate the effect on changes in child’s withcerebral palsy conditions of ankle and child’s mobility over thelong time (over 1 year) in the treatment with BTX-A.Method. 98 children with cerebral palsy were treated. The mainindication for the treatment of BTX- A was a dynamic ankle jointcontracture, resulting in functional status or movement disorders.Condition of all children were evaluated 1 month before starting thetreatment with BTX; prior to each injection; within 1 – 2 monthsafter the beginning of treatment with Dysport and after 4 monthswhile planning further treatment with botulinum toxin.The passive ROM of child’s ankle joint was assessed withgoniometer measuring the ankle of dorsiflexion while stretching thechild’s knee. The functional movement of the child was assessedusing the GMFM -88 scale.Results. The average age of children after first BTX-A injectionwas 33.29 ± 16.235 months. The majority of children (n = 45) weremobile belonging to I – II level at the GMFCS and partly mobilebelonging to level III (n = 35). The number of injections of BTX–A ranged from 2 to 8 times per child. The data suggest that despitelong-term treatment with BTX –A and physical therapy with theincrease of child’s age the contracture of the ankle joint forms. Inall cases the only criteria which are statistically significant is time.It means that passive changes in ankle joint dorsiflexion dependon its treatment time.Assessment of child’s functional movement with GMFM -88scale showed that with each injection of BTX –A the functionalmovement of a child is enhanced. The highest improvement inmotion has been established after the sixth injection of botulinumtoxin.Conclusion. Treatment with BTX-A doesn’t have an impacton increase of passive amplitude of ankle and it doesn‘t affectthe formation of contractures. Functional movements of a childimprovement depend on treatment time: the best result was reachedafter sixth injection of BTX.

Keyword(s): botulinum toxin, cerebral palsy, spasticity.
DOI: 10.5200/sm-hs.2015.010
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