Annals of Rehabilitation Medicine

"Botulinum A toxin"

Original Article

Botulinum Toxin Treatment on Upper Limb Function in School Age Children With Bilateral Spastic Cerebral Palsy: One Year Follow-up: Jee Sun Lee, Kyu Bum Lee, Yu Ryun Lee, You Nam Choi, Chul Woo Park, Sang Duck Park, Dong Hwa Jung, Chul Sang Lee; Ann Rehabil Med 2013;37(3):328-335. Published online June 30, 2013; DOI: https://doi.org/10.5535/arm.2013.37.3.328

Abstract
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Objective

To prospectively investigate the long-term effects of botulinum toxin treatment on the upper limb function and performance of school age children with spastic bilateral cerebral palsy, who have limitations in performing activities of daily living and school activities, due to spasticity of the upper extremities.

Methods

Botulinum type A toxin (BoNT-A) was injected into 24 spastic upper limbs of 15 children. We used a Modified Ashworth Scale and a Modified Tardieu Scale for the evaluation of upper limb spasticity, and Quality of Upper Extremity Skills Test (QUEST), Canadian Occupational Performance Measure (COPM), and Test of Visual-Motor Skills-Revised (TVMS-R) for the evaluation of upper limb function and performance.

Results

Upper limb spasticity continuously decreased until the end of the one-year follow-up. Upper limb function on QUEST and COPM showed the best performance at 3 months and deteriorated slightly, but still showed a significantly better performance at 9 and 12 months than at pre-injection. In more functional nine subjects who could perform TVMS-R, the performance enhancement effects remained constant after 12 months, suggesting that the reduced spasticity led to the learning effect acquired by the repeated use of the affected upper limb.

Conclusion

For school age children with bilateral spastic cerebral palsy whose upper limb functions are important, BoNT-A injections seem to be of help in the performance of school activities and activities of daily living.

Citations

Citations to this article as recorded by

Effectiveness of upper extremity BoNT-A Treatment followed by rehabilitation approaches on activity and participation in children with cerebral palsy: A systematic review
Hande Fidan, Hasan Bingöl, Mintaze Kerem Günel
Journal of Bodywork and Movement Therapies.2024; 40: 2017. CrossRef
Upper-extremity Spasticity-reducing Treatment in Adjunct to Movement Training and Orthoses in Children with Cerebral Palsy at Gross Motor Function- and Manual Ability Classification System Levels IV-V: A Descriptive Study
Gerd Andersson, Barbro Renström, Izabela Blaszczyk, Erik Domellöf
Developmental Neurorehabilitation.2020; 23(6): 349. CrossRef
Surgical treatment outcome of wrist flexion contracture in children with cerebral palsy through temporary extra-articular arthrodesis
Vladimir A. Novikov, Valery V. Umnov, Dmitry V. Umnov
Pediatric Traumatology, Orthopaedics and Reconstructive Surgery.2020; 8(3): 281. CrossRef
Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review
Véronique F P Plasschaert, Johanna E Vriezekolk, Pauline B M Aarts, Alexander C H Geurts, Cornelia H M Van den Ende
Developmental Medicine & Child Neurology.2019; 61(8): 899. CrossRef
Pathological and physiological muscle co-activation during active elbow extension in children with unilateral cerebral palsy
A. Sarcher, M. Raison, F. Leboeuf, B. Perrouin-Verbe, S. Brochard, R. Gross
Clinical Neurophysiology.2017; 128(1): 4. CrossRef
Benefits of Tendon Transfer Surgery in Cerebral Palsy

AAP Grand Rounds.2015; 34(2): 17. CrossRef
Tendon Transfer Surgery in Upper-Extremity Cerebral Palsy Is More Effective Than Botulinum Toxin Injections or Regular, Ongoing Therapy
Ann E. Van Heest, Anita Bagley, Fred Molitor, Michelle A. James
Journal of Bone and Joint Surgery.2015; 97(7): 529. CrossRef
Potential of Botulinum toxin A to treat upper extremity spasticity in children with cerebral palsy
Irene Nikaina, Antigone Papavasiliou
Toxin Reviews.2014; 33(3): 107. CrossRef

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Case Reports

CT Guided Botulinum Toxin Injection in Piriformis Syndrome.: Kim, Chul , Park, Yong Bum , Kim, Duk You; J Korean Acad Rehabil Med 2009;33(3):353-356.

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The traditional treatment of piriformis syndrome includes heat modality, deep muscle massage, slow stretch exercise, injection of local anesthetics, and surgical division of piriformis muscles in some selected cases. More recently, the use of botulinum toxin (BTX) for the treatment of piriformis syndrome has been suggested. We experienced two cases of piriformis syndrome with distinctive clinical feature. The symptoms of these two cases were not controlled by conservative managements including physical therapy, direct injection of lidocaine or steroid, or caudal block. So we injected Type A BTX in the piriformis muscle with the guidance of CT scan. 8 weeks after the botulinum injection, symptoms had almost completely disappeared, and follow up CT scan showed sufficient atrophy of piriformis muscles. The CT guided BTX injection in the piriformis muscle might emerge as a feasible technique to obtain a good local therapeutic effect without risk of imprecise inoculation. (J Korean Acad Rehab Med 2009; 33: 353- 356)

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Type A Botulinum Toxin Therapy on Thoracic Outlet Syndrome: A case report.: Shin, Yong Beom , Sohn, Hyun Joo , Chang, Jae Hyeok , Park, Hyoung Uk , Cha, Young Sun , Ko, Hyun Yoon; J Korean Acad Rehabil Med 2008;32(1):119-122.

Abstract
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The true neurogenic thoracic outlet syndrome (TOS), one type of the TOS, has vague and controversial clinical symptoms, so a variety of diseases can mimic the presentation of TOS, especially ulnar neuropathy or cervical root lesion. For most patients with TOS, common practice is to offer a course of conservative treatment, but its kinds are not enough and pain is too severe to do that in the chronic state. We experienced a case of true neurogenic thoracic outlet syndrome with distinctive clinical symptom and abnormal electrodiagnostic findings. The symptom was not controlled by conservative management including oral medication or physical therapy. So we injected type A botulinum toxin (Botox^Ⱂ) in the scalene and pectoralis minor muscles with ultrasonography guide. After 2 weeks, the pain decreased in visual analogue scale nine to four, and the compliance to physical therapy was improved. The result appeared to demonstrate that botulinum toxin injection may be helpful in controlling symptoms and making the patient adapt in physical therapy in the difficult case to management by any other methods. (J Korean Acad Rehab Med 2008; 32: 119-122)