Treatment of the Spasticity in Children with Cerebral Palsy

Ajša Meholjić-Fetahović

doi:10.17305/bjbms.2007.3028

Ajša Meholjić-Fetahović

Open Access

https://doi.org/10.17305/bjbms.2007.3028

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Abstract

Botulinum toxin is a natural purified protein and one of the strongest biological poisons--neurotoxin. It is produced by the bacterium Clostridium botulinum. Its medical usage started in USA in 1981 and in Europe in 1992. There are seven different immune types of the toxin: A, B, C1, D, E, F and G. Toxin types A and B are used to decrease muscular spasticity. Botulinum toxin prevents the formation of acetylcholine from cholinergic nerve tissues in muscles, which in the end irreversibly destroys neuromuscular synapses. It is called temporary local chemodenervation. It does not affect the synthesis of acetylcholine. As it affects neuromuscular bond it also affects one of the symptoms of cerebral palsy--spasticity. Decreasing the spasticity of children with cerebral palsy leads to the improvement of conscious movements, muscles are less toned, passive mobility is improved, orthosis tolerance is also improved, and the child is enabled to perform easier and better motor functions such as crawling, standing and walking. Since the action of Botulinum toxin is limited to 2-6 months, new neural collaterals are formed and neuromuscular conductivity is reestablished which in the end once again develops a muscular spasm. This leads to a conclusion that botulinum toxin should again be applied into spastic muscles. It is very important for good effect of Botulinum toxin to set the goals of the therapy in advance. The goals include improvement of a function, prevention of contractions and deformities, ease of care and decrease of pain for children with cerebral palsy. After application of botulinum toxin, it is necessary to perform adequate and intensive physical treatment with regular monitoring of effects. This work shows a case of a boy with spastic form of cerebral palsy. After being rehabilitated using Vojta therapy and Bobath concept and the conduct of certain physical procedures, botulinum toxin is administered into his lower limbs' muscles and kinesiotherapy is intensified. After the administration of botulinum toxin significant functional improvement is noted.

Highlights

Cerebral palsy represents a set of symptoms that developed as a result of abnormal brain development or brain damage during intrauterine development, labor or at an early stage of post delivery period
Botulinum toxin is recommended for treatment of: a) Dynamic equines of a walking foot b) Dynamic knee flexor decrease resulting in a flexed walk as well as a flexed knee while laying c) Scissor walking d) Decrease of a thumb’s abduction into the palm e) Improvement of a hand’s position in a radio carpal joint and elbow ( )
The boy has developed a clinical picture of a spastic form of cerebral palsy which was treated with Vojta method and Bobath concept kinezitherapy

Summary

Introduction

Cerebral palsy represents a set of symptoms that developed as a result of abnormal brain development or brain damage during intrauterine development, labor or at an early stage of post delivery period It is the most common reason of severe handicap in childhood ( , ). Due to a damage of the upper motor neuron and the resulting absence of inhibitory influence of higher centers, the development of the child is disturbed. As a result of damage of an upper motor neuron and due to the absence of inhibitory influence of higher centers, spasticity or highly increased muscle tonus is observed with children with cerebral palsy. We treat muscle spasticity if it disturbs the function, causes deformations and negatively influences the ability and quality of a child’s life For this purpose we use Botulinum toxin.

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