Functional outcomes of multilevel botulinum toxin and comprehensive rehabilitation in cerebral palsy

Balbaloglu O. | Basaran A. | Ayoglu H.

Article | 2011 | Journal of Child Neurology26 ( 4 ) , pp.482 - 487

The objective of this study was to measure the effect of lower extremity multilevel botulinum toxin A injections and comprehensive rehabilitation on spasticity and to determine the functional gains in ambulatory children with cerebral palsy. Sixteen ambulatory children with spastic cerebral palsy (9 hemiplegic, 7 diplegic), aged between 3 and 8 years, who were able to walk with or without assistance (Gross Motor Functional Classification System I-III) were recruited to the study. Botulinum toxin A injections were applied to a total of 23 extremities, followed by a comprehensive rehabilitation program. Walking distance and walking sp . . .eed (evaluated by the Six-Minute Walk Test) were significantly improved after treatment. Similarly, scores on the Observational Gait Scale (assessed by video gait analysis) increased significantly. Improvements in muscle length, spasticity, and selectivity were recorded. Reduced muscle spasticity after botulinum toxin A injections in children with cerebral palsy, with a comprehensive rehabilitation program, enabled clinically relevant improvements in functional ability. © 2011 The Author(s) Daha fazlası Daha az

Long-Term Effect of Botulinum Toxin in the Treatment of Benign Essential Blepharospasm and Hemifacial Spasm

Akdemir, Mehmet Orcun | Ugurbas, Silay Canturk | Ugurbas, Suat Hayri


Objectives: In this study, we evaluated the long-term effects of botulinum toxin A (BTA) in patients diagnosed with benign essential blepharospasm (BEB) and hemifacial spasm (HFS) comparing the drug dose in early and late periods and mean duration of relief. Materials and Methods: The records of patients who were treated with BTA for BEB and HFS were analyzed retrospectively. The patients who had < 10 injections and did not attend the follow-up examinations were excluded from the study. The first and last 5 injection doses and the mean duration of relief in 12 patients were compared between the groups. Results: Of the 12 patients, 6 . . . (4 females, 2 males) had treatment for BEB and 6 (5 females, 1 male) for HFS. The mean follow-up was 66.17 months for all patients, 51.83 months in the BEB group and 90.33 months in the HFS group. Average treatment dose was 40.79 U for BEB group and 29.07 U for HFS group. Mean duration of relief time was 16.1 weeks after the first 5 injections and 18.9 weeks after the last 5 injections (p=0.172). In HFS group, mean duration of relief time was 23.6 weeks after the first 5 injections and 23.0 weeks after the last 5 injections (p=0.463). In BEB group, mean duration of relief after the last 5 injections was increased by 2.7 weeks compared with the first 5 injections. Conclusion: BTA injection is a safe and effective method in the treatment of BEB and HFS. With similar injection doses in long-term, the mean duration of relief time after treatment was unchanged in the HFS group and was increased in the BEB group, although the difference was not statistically significant Daha fazlası Daha az

The Effect of the Botulinum Toxin-A on Craniofacial Development An Experimental Study

Babuccu, Berfu | Babuccu, Orhan | Yurdakan, Gamze | Ankarali, Handan

Article | 2009 | ANNALS OF PLASTIC SURGERY63 ( 4 ) , pp.449 - 456

In this study, we developed a novel experimental model to evaluate muscular action on bone formation and remodeling by the help of Botulinum toxin-A (BTX). Forty-nine 15-day-old mate Wistar rats were put into 4 groups randomly. Group I was the control group. BTX 0.4 IU (0.05 mL) was injected into the right masseter muscle in group 2 and into right temporalis muscle in group 3. The same volume of sterile saline was given into the both above-mentioned muscles in group 4. At the end of the fourth month, all animals were killed. Histology and weight of the masseter and temporalis muscles were studied. Thirty different osteometric measur . . .ements were also taken from skulls. Significant atrophy in BTX injected muscles was observed in groups 2 and 3. In group 4 (saline injection), only few osteometric measurements were significantly reduced, indicating the effect of the injection itself. Both groups 2 and 3 have apparent decrease in nasal bone, premaxilla, maxilla, and zygomatic dimensions on the injected side. When masseter group was compared with control and saline groups, no significant difference was found in skull base dimensions and mandibular length. In contrast, temporal group has also shown significant decrease in skull base dimensions. Our conclusions are as follows: (1) With this model, it is possible to study muscular action on bone formation and modeling without any surgical intervention, that is, by avoiding surgical artifacts, such as scar and contracture; (2) denervation of the skeletal muscles with BTX during the growing phase does effect bone development in a negative way; (3) pediatric use of the BTX deserves reevaluation under the light of these findings Daha fazlası Daha az


Basaran, Aynur | Emre, Ufuk | Karadavut, Kiymet Ikbal | Bulmus, Nercivan

Article | 2012 | JOURNAL OF REHABILITATION MEDICINE44 ( 7 ) , pp.541 - 546

Objective: To determine the effect of botulinum toxin A on spasticity and somatosensory evoked potentials of hand muscles in patients who have undergone cerebrovascular accident. Design: Preliminary, prospective, before-after study design. Patients: Six subjects prospectively followed after application of botulinum toxin A in the rehabilitation department of a university hospital. Methods: All patients underwent botulinum toxin A injection to the upper extremity muscles in varying combinations and carried out a home-based exercise programme. Primary outcome measure was median somatosensory evoked potential of hand muscles (N20). Sec . . .ondary outcome measures were: spasticity assessed clinically by Modified Ashworth Scales (MAS); functional ability analysis assessed by Physician's Rating Scale (PRS); and functional difficulties reported by patients or their care-givers by patient disability and care-giver burden rating scale (PD & CBRS). Results: MAS, PRS and PD & CBRS improved with botulinum toxin A treatment. In the affected limb, N20 potentials were impaired compared with those in the unaffected side. With botulinum toxin A treatment, although improvement in overall N20-P25 amplitudes was significant, as a result of limited sample size, post hoc pair-wise comparisons with Bonferroni correction failed to yield any significant pairs. Conclusion: The improvement in the median somatosensory evoked potentials following botulinum toxin A treatment suggests that central somatosensory patterns in hemiplegia can be modified by peripheral inputs Daha fazlası Daha az

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