ABSTRACT
AIM: To analyze the efficacy and safety of dose ranges of abobotulinum toxin A (BTA) for multilevel injections into upper and lower extremity muscles in children with spastic forms of cerebral palsy (CP). MATERIAL AND METHODS: We analyzed retrospectively multilevel BTA injections for 216 patients, aged from 2 to 17 years. Children received 1-6 repeated injections and complex physiotherapy. Patients were classified according to the GMFCS. Treatment results were evaluated with the modified Ashworth and Tardieu scales. RESULTS: Multilevel BTA injections were indicated for the most (89/8%) of the patients with spastic forms of CP, and in most of them the total dosage exceeded 30 U/kg. In the bilateral forms of CP, the total dosage (U and U/kg) was higher compared to the unilateral forms. Doses for each muscle in U/kg were similar in all CP forms. The total doses of BTA and the intervals between the repeated injections were stable for each patient. CONCLUSION: The dose ranges suggested for CP are effective and safe for the reduction of spasticity in several functional segments of upper and lower extremities in one treatment session.
ABSTRACT
We studied 67 children, aged 2-9 years, with cerebral palsy including 56 children with a spastic form. An electromyographic method was used for the development of optimal tactics of botulinum toxin type A injections in different clinical presentations of spasticity. The best clinical results were obtained in children with the following changes on EMG: 1) the tonic muscle activity in resting state was minimal (<10 microvolts) and had local or regional distribution; 2) the pathological synkinetic activity during voluntary movements was minimal (synergetic activity coefficient for shin muscles was less than 0.45); 3) the disturbance of interactions between synergistic and antagonistic muscles was moderate (reciprocity coefficient was not less than 0.4); 4) EMG amplitude in voluntary muscle contraction should not be less than 150 microvolts. This approach to the treatment allowed to reach higher levels on The Gross Motor Function Classification System in part of children.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Cerebral Palsy/drug therapy , Electromyography/methods , Muscle Contraction/drug effects , Muscle Spasticity/drug therapy , Muscle, Skeletal/physiopathology , Practice Guidelines as Topic/standards , Cerebral Palsy/complications , Cerebral Palsy/physiopathology , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Humans , Injections, Intramuscular , Leg/physiopathology , Male , Muscle Spasticity/etiology , Muscle Spasticity/physiopathology , Muscle, Skeletal/drug effects , Neuromuscular Agents/administration & dosage , Treatment OutcomeABSTRACT
Infrared absorption spectra and internal rotation of 1,2-di-(p-XC(6)H(4))ethanes (X=H, Br, NO(2)) in crystalline phase, liquid and solutions at various temperatures have been investigated. Band fitting was applied to conformationally sensitive regions of the spectra, and assignment of the peaks to trans and gauche conformations was performed. Enthalpy and entropy differences of the conformers (deltaH(0) and deltaS(0)) were found to be solvent-dependent, and it is interpreted in terms of previously discovered compensation effect. The values deltaH(0) and deltaS(0) for 1,2-di-(p-NO(2)C(6)H(4))ethane obtained are unusually large.
