USE OF BOTULINUM TOXIN IN SPASTIC CEREBRAL PALSY, REVIEW OF LITERATURE

  • Marko Aleksić Institute For Orthopaedic Surgical Diseases "Banjica", Belgrade Serbia
  • Zoran Baščarević Institute For Orthopaedic Surgical Diseases "Banjica", Belgrade Serbia

Abstract


Botulinum toxin type A is a protein that is synthetized by Clostridium botulinum. It represents one of the most potent toxins in nature. It is a cause of poisoning (botulism), but it also has a beneficial effect on reducing muscle spasm and has found widespread use in medicine, with indications increasing year by year. If properly dosed, complications are rare and without major consequences.

In the treatment of spastic cerebral palsy, it is beneficial in reduction of spasm. The effect is localized and systemic side effects are absent. The patient's acceptance of this therapy is very good. The effect on the gait pattern can be maintained at a satisfactory level between 3 and 6 months after administration. The interval between therapies is about 3 months, provided that constant control of motor function of the spastic limb is ensured. Better results are achieved on passive movements than active movements. Effects are transient and reversible. Therapy should be started at an early age before the development of contractures, because deformity can be prevented.

Botulinum toxin type A therapy is considered to be the pharmacological therapy of choice in the treatment of spastic deformities in patients with cerebral palsy, due to its reversible effects, low rate of side effects, painlessness, and the possibility of repeated therapy.

Keywords: cerebral palsy, botulinum toxin, spastic deformity, electromyoneurography, skeletal muscle

Author Biographies

Marko Aleksić, Institute For Orthopaedic Surgical Diseases "Banjica", Belgrade Serbia
Medical doctor, Orthopaedic and trauma surgery specialist.
Zoran Baščarević, Institute For Orthopaedic Surgical Diseases "Banjica", Belgrade Serbia

Medical doctor, Orthopaedic and trauma surgery specialist,

Professor of surgery, Medical School, University of Belgrade

References

Erbgurth F, Naumann M. Historical aspects of botulinum toxin: Justinus Kerner (1786-1862) and the “sausage poison”. Neurology 1999; 53:1850-1853.

Erbguth F, Naumann M. On the First Systematic Descriptions of Botulism and Botulinum Toxin by Justinus Kerner (1768-1862). Journal of the History of the Neurosciences. 2000; Vol. 9, 2:218-220.

Lang A. History of uses of BOTOX (Botulinum Toxin Type A), Lippincott’s Case Management,2004; 2: 109-12.

Koman L, Mooney J, Smith B, Goodman A, Mulvaney T. Management of spasticity in cerebral palsy with botulinum A toxin; report of a preliminary, randomized double blind trial, J Pediatr Orthop, 1994;14: 299–303.

Prevot AR, Brygoo ER. New investigations on botulinism and its five toxic types. Ann Inst Pasteur (Paris). 1953 Nov;85(5):544-75.

Hatheway CL. Botulism: the present status of the disease. Curr Top Microbiol Immunol. 1995;195:55-75.

Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med, 1998; 129:(3): 221-228.

Bakheit, A. Magid O. Botulinum Toxin Treatment of Muscle Spasticity. AuthorHouse UK, 2007. 2nd ed. pp.37-63.

Schiavo G, Rossetto O, Tonello F, Monteccuco C. Intracellular targets and metallprotease activity of tetanus and botulism neurotoxins. Curr Top Microbiol Immunol. 1995; 195:257-74.

Devriese PP. On discovery of Clostridium botulinum. J Hist Neurosci 1999; 8:43-50.

Blasi J, Chapman ER, Link E, biny T, Yamasaki S, De Camilli P, Sudhof TC, Neimann H and Jahn R. Botulinum neurotoxin A selectively cleaves the synaptic protein SNAP-25. Nature, 1993;365: 160-163.

Schiavo G, Rossetto O, Monteccuco C. Clostridial neurotoxins as tools to investigate the molecular events of neurotransmittal release. Semin Cell Biol. 1994; Aug; 5(4):221-9.

Zuber M, Sebald M, Bathien N, de Recondot J, Rondot P. Botulinum antibodies in dystonic patients treated with type A bolutilinum toxin: frequency and siginificance. Neurology 1993; 43(9):1715-8.

Greene P, Fahn S, Diamond B. Development of resistance to botulinum toxin type A in patients with torticolis. Mov. Disord. 1994; 9(2):213-17.

Brin MF. Botulinum Toxin. Chemistry, Pharmacology, Toxicity and Immunology. Muscle & Nerve. 1997; Suppl. 6:146-168.

Hambleton P and Moore P. Botulinum Neurotoxins. Origin Structure, Molecular Actions and Antibodies. In Botulinumtoxin Treatment (P. Moore. Ed.). Blackwell Science Ltd. Oxford Cambridge. 1997; pp. 16-27.

Vukašinović Z. i saradnici. Opšta ortopedija, Beograd: Institut za ortopedsko-hirurške bolesti “Banjica”. 2002; pp. 283-300.

Čobeljić G, Bajin Z, Lešić A, Bumbaširević M. Time Course of spastic skeletal muscle after application of Botulinum toxin (Dysport). Acta Veterinaria (Beograd), 2007; vol. 57: No. 2-3, 103-111.

Katzung BG. Basic and Clinical Pharmacology, McGraw Hill LANGE, Medical book, 2007; 10th ed. pp:333-511.

Čobeljić G, Bumbaširević M, Lešić A, Bajin Z. The management of spastic equinus in cerebral palsy. Orthopaedics and trauma. Elsevier Ltd. 2009; 23:3, 201-208.

Kanovsky P, Streitova H, Lnenička J, Bareš, Kubova D, Hortova H. Induction of changes in motor pattern in children affected by cerebral palsy as a result of simultaneous rehabilitation and botulinum toxin A therapy. Čes.a Slov. Neurol. Neurochir. 1999; 62/95, 4; 203-208.

Thompson NS, Baker RJ, Cosgrove AP, Corry IS, Graham HK. Musculoskeletal modelling in determining the effect of botulinum toxin on the hamstrings of patients with crouch gait. Dev Med Child Neurol. 1998; Sep;40(9):622-5.

Ubhi T, Bhakta BB, Ives HL, Allgar V, Roussounis SH. Randomised double blind placebo controlled trial of the effect of Botulinum toxin on walking in cerebral palsy. Arch Du Child. 2000; 341:481-487.

Yap R, Majnemer A, Benaroch T, Cantin MA. Determinants of responsiveness to botulinum toxin, casting, and bracing in the treatment of spastic equinus in children with cerebral palsy. Dev Med Child Neurol. 2010. Feb; 52(2):186-93.

Gooch JL, Sandell TV. Botulinum Toxin for Spasticity and Athetosis in Children With Cerebral Palsy. Arch Phys Med Rehabil. 1997; Vol. 77:508-511.

Published
2019/09/17
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