Experience in the management of botulinum toxin 500 units in children with cerebral palsy

Abstract

Spasticity is a sequel of central nervous system injury and therefore children with cerebral palsy, which interferes with voluntary activity, causes delayed motor development, problems with postural control , favoring the appearance of deformities and pain. Botulinum toxin has been shown to control spasticity by blocking the release of acetylcholine in the injected muscles, Experience in the use of botulinum toxin in
children 500 units is still poor and in Colombia there is not publication about the use in this population group. Control of spasticity in children with cerebral palsy is a necessary and complementary strategy in Physical Rehabilitation.

Objectives: Evaluate the reduction of spasticity in children with cerebral palsy seen in Fundacion Hospital La Misericordia , by modified Ashworth scale, taking into account dose, number of points and diagnostic , to document the impact of the application of 500 units of botulinum toxin on clinical experience.

Subjects: 40 patients with a diagnosis of cerebral palsy, between 2 and 17 years. Botulinum toxin application was performed under ultrasound guidance and electrical stimulation.

Materials and methods: Clinical trial prospective longitudinal quasi-experimental. Caregivers and parents signed consent informed prior to the application of the drug. The drug was applied under anesthesia with ultrasound guidance as guidance and electrical stimulation. Initial clinical assessment was performed using the Ashworth scale and goniometry, 8 days and 1 month after application of the drug. Spasticity was
assessed by the modified Ashworth scale, was held goniometry and side effects through the application form designed for that purpose. We applied 500 units botulinum toxin (Dysport) to 40 patients with cerebral palsy aged 2 to 17 years, assessed in consultation Physiatry in La Fundación Hospital La Misericordia, 25 (62.5%) were cuadriparéticos, 7 (17.5%) were diparéticos and 8 (20%) hemiparetic. We used principal component analysis and descriptive analysis. The analysis was performed with SPSS 20 and non parametric statistical tests

Results: Patients with quadriplegia, had greater impact with doses close to 500 u. By applying higher doses was not observed significant increase in the control of spasticity. Patients with diparesia and quadriparesis a tend to have lower values in the Ashworth scale. Slight increase in the number of points showed significant changes in Ashworth scale. No significant adverse effects were observed in patients in the sample.

Conclusion: Significant response in reducing spasticity botulinum toxin application 500 units without side effects.