Yıl: 2019 Cilt: 30 Sayı: 2 Sayfa Aralığı: 155 - 162 Metin Dili: İngilizce DOI: 10.5606/ehc.2019.65453

Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy

Öz:
Objectives: This study aims to evaluate the clinical outcomes of children with spastic type cerebral palsy (CP) treated with botulinum toxin type A (BoNT-A) injection for lower limb contracture and the influence of age, gender, functional level and degree of initial contracture on treatment outcomes. Patients and methods: Clinical records at pre-BoNT-A injection and post-BoNT-A injections of 153 sessions of a total of 118 consecutive children (67 boys, 51 girls; mean age 5.9±2.6 years; range, 2.5-16 years) were retrospectively evaluated. Degrees of pre- and post-injection contracture were evaluated. Post-injection supplemental casting for 10 days was recorded in all cases. Less than 20° of hip flexion contracture, more than 30° of hip abduction, a negative prone Ely test, less than 50° of popliteal angle and at least 5° of ankle dorsiflexion values at post-injection were accepted as sufficient clinical improvement. Results: Sufficient post-injection range of motion (ROM) was observed in 80% of cases with hip flexion contracture, in 45% of cases with hip adduction contracture, in 84% of cases with knee flexion contracture and in 77% of cases with ankle equinus contracture. Prone Ely test that was positive in 60% of cases with knee extension contracture was negative at post-injection. Improvement in contractures were prominent in children with lesser degree initial contractures. Conclusion: Botulinum toxin type A injection increases ROM in hip, knee and ankle joint contractures in CP. Although age, gender and functional level may influence the clinical outcomes, pre-treatment level of contracture is the main determinant in improvement in ROM at post-injection.
Anahtar Kelime:

Botulinum toksin tip A enjeksiyonu serebral palsili çocukların kalça, diz ve ayak bileği eklemi kontraktürlerinde hareket açıklığını artırır

Öz:
Amaç: Bu çalışmada alt ekstremite kontraktürü nedeniyle botulinum toksin tip A (BoNT-A) enjeksiyonu ile tedavi edilen spastik tip serebral palsi (SP)’li çocukların klinik sonuçları ve yaşın, cinsiyetin, fonksiyonel düzeyin ve başlangıç kontraktür derecesinin tedavi sonuçlarına etkisi değerlendirildi. Hastalar ve yöntemler: Toplam 118 ardışık çocuğun (67 erkek, 51 kız; ort. yaş 5.9±2.6 yıl; dağılım, 2.5-16 yıl) BoNT-A enjeksiyonu öncesi ve 153 seanslık BoNT-A enjeksiyonu sonrası klinik kayıtları retrospektif olarak değerlendirildi. Enjeksiyon öncesi ve sonrası kontraktür dereceleri değerlendirildi. Tüm olgularda enjeksiyon sonrası 10 günlük tamamlayıcı alçı uygulaması kayıt edildi. Enjeksiyon sonrası 20°’nin altında kalça fleksiyon kontraktürü, 30°’den fazla kalça abdüksiyonu, negatif pron Ely testi, 50°’nin altında popliteal açı ve en az 5° ayak bileği dorsifleksiyon değerleri yeterli klinik düzelme olarak kabul edildi. Bulgular: Kalça fleksiyon kontraktürü olan olguların %80’inde, kalça adduksiyon kontraktürü olan olguların %45’inde, diz fleksiyon kontraktürü olan olguların %84’ünde ve ayak bileği ekin kontraktürü olan olguların %77’sinde enjeksiyon sonrası yeterli eklem hareket açıklığı (EHA) görüldü. Diz ekstansiyon kontraktürü olan olguların %60’ında pozitif olan pron Ely testi enjeksiyon sonrası negatif idi. Başlangıç kontraktür düzeyi daha düşük olan çocuklarda kontraktürde iyileşme belirgin idi. Sonuç: Botulinum toksin tip A enjeksiyonu SP’de kalça, diz ve ayak bileği kontraktürlerinde EHA’yı artırır. Yaş, cinsiyet ve fonksiyonel düzey klinik sonuçları etkileyebilse de enjeksiyon sonrası EHA’daki iyileşme üzerinde temel belirleyici tedavi öncesi kontraktür derecesidir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Molenaers G, Fagard K, Van Campenhout A, Desloovere K. Botulinum toxin A treatment of the lower extremities in children with cerebral palsy. J Child Orthop 2013;7:383-7.
  • Copeland L, Edwards P, Thorley M, Donaghey S, Gascoigne-Pees L, Kentish M, et al. Botulinum toxin A for nonambulatory children with cerebral palsy: a double blind randomized controlled trial. J Pediatr 2014;165:140-6.
  • Ferrari A, Maoret AR, Muzzini S, Alboresi S, Lombardi F, Sgandurra G, et al. A randomized trial of upper limb botulimun toxin versus placebo injection, combined with physiotherapy, in children with hemiplegia. Res Dev Disabil 2014;35:2505-13.
  • Ade-Hall RA, Moore AP. Botulinum toxin type A in the treatment of lower limb spasticity in cerebral palsy. Cochrane Database Syst Rev 2000;2:CD001408.
  • Oto M, Sarıkaya İA, Erdal OA, Şeker A. Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy. Eklem Hastalik Cerrahisi 2018;29:8-12.
  • Reddihough DS, King JA, Coleman GJ, Fosang A, McCoy AT, Thomason P, et al. Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy. Dev Med Child Neurol 2002;44:820-7.
  • Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214-23.
  • Trost J. Physical assessment and observational gait analysis. In: Gage. JR, editor. The treatment of gait problems in cerebral palsy. London: Mac Keith Press; 2004. p. 71-89.
  • Heinen F, Molenaers G, Fairhurst C, Carr LJ, Desloovere K, Chaleat Valayer E, et al. European consensus table 2006 on botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2006;10:215-25.
  • Van Campenhout A, Molenaers G. Localization of the motor endplate zone in human skeletal muscles of the lower limb: anatomical guidelines for injection with botulinum toxin. Dev Med Child Neurol 2011;53:108-19.
  • Delgado MR. The use of botulinum toxin type A in children with cerebral palsy: A retrospective study. Eur J Neurol 1999;6:11-8.
  • Gormley ME, Gaebler-Spira D, Delgado MR. Use of botulinum toxin type A in pediatric patients with cerebral palsy: a three-center retrospective chart review. J Child Neurol 2001;16:113-8.
  • Linder M, Schindler G, Michaelis U, Stein S, Kirschner J, Mall V, et al. Medium-term functional benefits in children with cerebral palsy treated with botulinum toxin type A: 1-year follow-up using gross motor function measure. Eur J Neurol 2001;8:120-6.
  • Gonnade N, Lokhande V, Ajij M, Gaur A, Shukla K. Phenol versus botulinum toxin a injection in ambulatory cerebral palsy spastic diplegia: A comparative study. J Pediatr Neurosci 2017;12:338-43.
  • 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;88:161-70.
  • Molenaers G, Van Campenhout A, Fagard K, De Cat J, Desloovere K. The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb. J Child Orthop 2010;4:183-95.
  • Lofterød B, Terjesen T. Results of treatment when orthopaedic surgeons follow gait-analysis recommendations in children with CP. Dev Med Child Neurol 2008;50:503-9.
  • Atik OŞ. Which articles do we prefer to publish? Eklem Hastalik Cerrahisi 2018;29:1.
  • Koman LA, Brashear A, Rosenfeld S, Chambers H, Russman B, Rang M, et al. Botulinum toxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial. Pediatrics 2001;108:1062-71.
  • Albavera-Hernández C, Rodríguez JM, Idrovo AJ. Safety of botulinum toxin type A among children with spasticity secondary to cerebral palsy: a systematic review of randomized clinical trials. Clin Rehabil 2009;23:394-407.
  • Delgado MR, Bonikowski M, Carranza J, Dabrowski E, Matthews D, Russman B, et al. Safety and efficacy of repeat open-label abobotulinumtoxina treatment in pediatric cerebral palsy. J Child Neurol 2017;32:1058-64.
  • Desloovere K, Molenaers G, Jonkers I, De Cat J, De Borre L, Nijs J, et al. A randomized study of combined botulinum toxin type A and casting in the ambulant child with cerebral palsy using objective outcome measures. Eur J Neurol 2001;8:75-87.
APA AKTAŞ E, ÖMEROĞLU H (2019). Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. , 155 - 162. 10.5606/ehc.2019.65453
Chicago AKTAŞ Erdem,ÖMEROĞLU HAKAN Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. (2019): 155 - 162. 10.5606/ehc.2019.65453
MLA AKTAŞ Erdem,ÖMEROĞLU HAKAN Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. , 2019, ss.155 - 162. 10.5606/ehc.2019.65453
AMA AKTAŞ E,ÖMEROĞLU H Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. . 2019; 155 - 162. 10.5606/ehc.2019.65453
Vancouver AKTAŞ E,ÖMEROĞLU H Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. . 2019; 155 - 162. 10.5606/ehc.2019.65453
IEEE AKTAŞ E,ÖMEROĞLU H "Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy." , ss.155 - 162, 2019. 10.5606/ehc.2019.65453
ISNAD AKTAŞ, Erdem - ÖMEROĞLU, HAKAN. "Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy". (2019), 155-162. https://doi.org/10.5606/ehc.2019.65453
APA AKTAŞ E, ÖMEROĞLU H (2019). Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 30(2), 155 - 162. 10.5606/ehc.2019.65453
Chicago AKTAŞ Erdem,ÖMEROĞLU HAKAN Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 30, no.2 (2019): 155 - 162. 10.5606/ehc.2019.65453
MLA AKTAŞ Erdem,ÖMEROĞLU HAKAN Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), vol.30, no.2, 2019, ss.155 - 162. 10.5606/ehc.2019.65453
AMA AKTAŞ E,ÖMEROĞLU H Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2019; 30(2): 155 - 162. 10.5606/ehc.2019.65453
Vancouver AKTAŞ E,ÖMEROĞLU H Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2019; 30(2): 155 - 162. 10.5606/ehc.2019.65453
IEEE AKTAŞ E,ÖMEROĞLU H "Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy." Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 30, ss.155 - 162, 2019. 10.5606/ehc.2019.65453
ISNAD AKTAŞ, Erdem - ÖMEROĞLU, HAKAN. "Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy". Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 30/2 (2019), 155-162. https://doi.org/10.5606/ehc.2019.65453