[Surgical treatment of hip subluxation and luxation in children with spinal hernia consequences]. / Khirurgicheskoe lechenie podvyvikha i vyvikha bedra u detei s posledstviiami spinnomozgovykh gryzh.

AIM: To determine surgical tactics for hip subluxation and luxation in children with spinal hernia consequences. MATERIAL AND METHODS: The study included 134 patients with hip subluxation and luxation with consequences of cerebrospinal hernias who were examined at the Turner Research Institute for Children's Orthopedics in 2006-2016. The main group consisted of 69 patients who received surgical treatment with hip joint stabilization. The control group included 65 children without surgery. Within each group patients were divided into 2 subgroups depending on level of spinal cord injury by using of Sharrard technique. RESULTS: In patients with high lesion (Th and LI-LII) surgical treatment led to impairment of motor function in most cases (71%) (archival material); in case of LIII-LIV and LV-SI segments 25 of 45 (55%) patients improved motor performance while in control group motor function was deteriorated in 13 of 35 (37%) cases. CONCLUSION: Neurosegmental level allows to predict the motor function and to determine surgical tactics.

[The First Russian Consensus on the Multilevel Abobotulinumtoxin A Injections in Spastic Forms of Cerebral Palsy]. / Pervyi Rossiiskii konsensus po primeneniyu mnogourovnevykh in''ektsii abobotulinumtoxin A pri lechenii spasticheskikh form detskogo tserebral'nogo paralicha.

Spasticity treatment is one of the key aspects of the contemporary cerebral palsy (CP) rehabilitation that influences on the effectiveness of other methods. The paper presents the first Russian document that unites the recommendations for the BTA treatment of CP and could be used as the guideline for the multilevel injections. The Russian consensus on the multilevel botulinum toxin A (BTA) treatment of spastic CP is based on the international data and the results of national studies. The authors describe typical CP spasticity patterns in the upper and lower extremities, give recommended intervals for the BTA (Abobotulinum toxin A) dosages for the whole injection procedure and for the separate muscles. The method of dosage calculation for functional segments is also described. Attention is paid to the frequency, optimal intervals between the repeated injections and the whole duration of BTA treatment. The authors discuss effectiveness and safety of BTA, factors that potentially influence the results of the injections, including ultrasound and electromyography control, and indications for the continuation and termination of treatment.

[Efficacy of botulinum toxin in the treatment of dynamic equinus and equinovarus foot deformities in children with hemiplegic cerebral palsy].

The objective of the study was to assess factors modulating the efficacy of botulinum toxin injections in the correction of dynamic equinus and equinovarus foot deformities in children with hemiplegic cerebral palsy. The efficacy of treatment was evaluated in 40 children. Clinical data including spasticity assessment by the original Ashworth scale, postural and gate changes were collected. Spasticity grade 4-5 by the Ashworth scale and retraction 90-120 degrees reduce the likelihood of successful correction of equinus contracture. Botulinum injections can be used as basic therapy. In cases of transient contracture more than 120 degrees, combined methods of treatment are recommended. The hindfoot varus less 30 degrees, which can be passively corrected before treatment and in the presence of the positive Coleman block test, more likely needs injection in triceps muscle for correction. If the hindfoot varus is more than 30 degrees and the Coleman block test is negative, the combined treatment is necessary.

[Botulinum toxine treatment and the formation of antibodies to botulotoxin in patients with cerebral palsy].

The aim of the study was to search for the association between efficacy of botulinum treatment (dysport) and the formation of antibodies to botulinum toxin in children with cerebral palsy (CP). Fourteen children with CP received dysport, 42 children (29 with CP and 13 patients with paresises of other etiologies) were not treated with this drug. No association between the presence of antibodies in blood serum and efficacy of treatment was found. However, further research of the role of antibody genesis as a factor influencing the formation of reaction to treatment is needed.

[Repetitive botulinum toxine injections in children with cerebral palsy: causes of parents' decline and the ways to resolve].

The refuse of the parents of the child with spastic cerebral palsy to use botulinum toxine as a part of multidisciplinary prolonged treatment can be destructive for the achievement of the goals of the rehabilitation. 65 parents of children with CP were assessed to clarify the substituted causes for rejection. Answers, caused by real adverse effects of the medication were rarest. Most of the parents were afraid of the reactions, which are the part of pharmaceutical effect. Psychological background and the opinion of the other persons are the most difficult causes to be resolved.

[Treatment of contractures of the lower extremity joints in patients with infantile cerebral palsy against the background of prolonged epidural blockade].

The authors describe specific effects of prolonged epidural blockade in treatment of contractures of the lower extremity joints in children with cerebral palsy. The method was used in 5 patients aged from 11 to 16 years. The prolonged epidural blockade during 4-5 weeks allowed adequate motor rehabilitation and conditions for learning to walk.