23. EVALUATION OF IMPROVEMENT IN LOWER LIMB MUSCLE RIGIDITY IN CHILDREN WITH CEREBRAL PALSY USING BOTULINUM TOXIN TYPE A IN CHILDREN’S HOSPITAL 1

Vo Quang Dinh Nam1, Lam Minh Chinh2
1 Hospital for Traumatology and Orthopaedics
2 Children's Hospital 1

Main Article Content

Abstract

Background: Children's Hospital 1 has been treating muscle stiffness in children with cerebral palsy using BoNT-A since 2018, but there has yet to be a comprehensive study summarizing and evaluating its actual effectiveness and existing challenges in order to refine the treatment protocol.


Research Objectives: To determine the rate of improvement in muscle stiffness symptoms in the lower limbs due to cerebral palsy using Botulinum Toxin Type A injections.


Subjects and Methods: This is a descriptive comparative study conducted before and after intervention on children diagnosed with “lower limb muscle stiffness due to cerebral palsy” treated with BoNT-A injections at the Orthopedic Department of Children's Hospital No. 1. A total sampling method was employed. Results were assessed using the modified Ashworth scale, GMFCS, and measuring the angle of spasticity at the following time points: 2 weeks, 1.5 months, 3 months, and 6 months post-injection.


Results: After 1.5 months post-injection, no cases were recorded at levels 2 and 3; primarily, cases were observed at level 1, accounting for 92.5%. The Ashworth score after 3 months indicated that the majority of children (60%) were at level 0, with 40% at level 1. After 6 months, a higher percentage (62.5%) was recorded at level 0. The GMFCS score before injection, after 2 weeks, and after 1.5 months showed that 72.5% of subjects were at level I, while 27.5% were in level II. After 6 months, 100% of subjects were classified as level I in the GMFCS. Before injection, 75% of subjects had a mean spasticity angle of 8.7 degrees. After 6 months, 75% of subjects had a mean spasticity angle of 12.75 degrees.


Conclusion: The increased use of BoNT-A for children with cerebral palsy exhibiting lower limb muscle stiffness is recommended. This method has proven effective in reducing muscle stiffness and improving motor function.

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References

[1] Nguyễn Thị Xuyên. Tài liệu số 10: Phục hồi chức năng cho trẻ bại não. Phục hồi chức năng dựa vào cộng đồng. Nhà xuất bản Y học Hà Nội; 2008.
[2] Trương Tấn Trung. Điều trị co cứng cơ ở trẻ bại não với độc tố botulinum toxin type A (bont A). Tạp chí Y học thực hành. 2015:137-140.
[3] Erbguth F. J. Botulinum toxin, a historical note. Lancet. 1998;351(9118):1820. Doi:10.1016/s0140-6736(05)78793-6
[4] Trương Tấn Trung. Điều trị co cứng cơ ở trẻ em bại não với Botulinum toxin típ A. Hội nghị thường niêu lần thứ XV, Hội Chấn thương Chỉnh hình TP Hồ Chí Minh. 2008:230-242.
[5] Võ Toàn Trung. Tổng quan về liệu pháp Botulinum toxin type A ở trẻ bại não. Hội nghị khoa học về bãi não. 2012:01-07.
[6] Davis, M. C., et al. Preterm Birth and Cerebral Palsy: A Population-Based Study. Pediatrics, 2014; 134(3): 650-657
[7] Gilbert, W., et al. Cerebral Palsy: An Overview. American Family Physician, 2016; 94(12): 1025-1032
[8] Ceyhan Bilgici M, et al. Quantitative Assessment of Muscle Stiffness with Acoustic Radiation Force Impulse Elastography after Botulinum Toxin A Injection in Children with Cerebral Palsy. J Med Ultrasonics. 2018;45:137-141.
[9] Tedroff K, Lowing K, Haglund-Akerlind Y, Gutierrez-Farewik E, Forssberg H. Botulinum toxin A treatment in toddlers with cerebral palsy: A randomized controlled trial. Pediatrics. 2009;123(5)
[10] 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(3):183-95.
[11] Galli M, Cimolin V, Rigoldi C, Tenore N, AlberVo Quang Dinh Nam, Lam Minh Chinh / Vietnam Journal of Community Medicine, Vol. 65, Special Issue 11, 125-131131 tini G. Gait patterns after botulinum toxin injections in children with cerebral palsy: a systematic review. Developmental Neurorehabilitation. 2014;17(1):2-8.
[12] Trương Tấn Trung. Điều trị co cứng cơ chi dưới ở trẻ bại não với độc tố botulinum týp a phối hợp tập phục hồi chức năng. Đại học Y Dược TP.HCM; 2017.
[13] Ubhi T, Bhakta BB, Ives HL, Allgar V, Roussounis SH. Randomized double blind placebo-controlled trial of the effect of Botulinum toxin on walking in cerebral palsy. Archives of Disease in Childhood. 2000;83(6):481-487.
[14] Pingel J, Bartels EM, Nielsen JB. New perspectives on the development of muscle contractures following central motor lesions: a narrative review. Annals of Physical and Rehabilitation Medicine. 2016;59(2):134-139.
[15] Khan, F., et al. "Effectiveness of Botulinum Toxin for Spasticity in Children with Cerebral Palsy: A Systematic Review." Journal of Child Neurology, 2018; 33(9): 571-578