Tratamiento con toxina botulínica en niños con parálisis cerebral espástica
Análisis del tratamiento en tríceps sural durante 2017-2018 en el Centro de Rehabilitación Infantil Teletón, Uruguay
Palabras clave:
PARÁLISIS CEREBRAL, TOXINAS BOTULÍNICAS, ESPASTICIDAD MUSCULAR, NIÑO
Resumen
Introducción: la parálisis cerebral (PC) es la causa más frecuente de discapacidad motriz en niños y adolescentes. En el 85% de los casos, la manifestación motora predominante es la espasticidad. Las inyecciones de toxina botulínica tipo A (TB-A) se han usado para reducir la espasticidad en niños con PC. No existen investigaciones a nivel nacional que comprueben si los resultados son comparables a los reportados en la literatura.
Objetivo: determinar el efecto del tratamiento con TB-A en el tríceps sural en conjunto con la rehabilitación física en niños con PC espástica durante los años 2017-2018 en el Centro de Rehabilitación Infantil Teletón, Uruguay.
Métodos: se realizó un estudio descriptivo, retrospectivo, de cohorte histórica única con seguimiento longitudinal, mediante la revisión de historias clínicas de los pacientes con PC con marcha independiente o asistida que recibieron tratamiento con TB-A para el tratamiento de la espasticidad del tríceps sural durante el período 2017-2018.
Resultados: se analizaron 40 procedimientos de inyección de TB-A. Se observó una buena respuesta al mes y a los 3 meses del tratamiento con TB-A, con mejoría del ángulo de dorsiflexión del pie con la rodilla en flexión y en extensión, mejoría del puntaje de la escala de espasticidad de Ashworth modificada y, en el 95% de los procedimientos, de la percepción subjetiva de los padres. Se observó una disminución del efecto hacia los 6 meses de la aplicación.
Conclusión: la aplicación de TB-A en el Centro Teletón muestra resultados positivos, comparables con los reportados en la bibliografía internacional.
Citas
1) Paneth N. Establishing the diagnosis of cerebral palsy. Clin Obstet Gynecol 2008; 51(4):742-8.
2) Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130(5):e1285-312.
3) Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep 2020; 20(2):3.
4) Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109:8-14.
5) Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, et al. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004; 62(6):851-63.
6) Multani I, Manji J, Hastings-Ison T, Khot A, Graham K. Botulinum toxin in the management of children with cerebral palsy. Paediatr Drugs 2019; 21(4):261-81.
7) Smith LR, Pichika R, Meza RC, Gillies AR, Baliki MN, Chambers HG, et al. Contribution of extracellular matrix components to the stiffness of skeletal muscle contractures in patients with cerebral palsy. Connect Tissue Res 2021; 62(3):287-98.
8) Schwabe AL. Comprehensive care in cerebral palsy. Phys Med Rehabil Clin N Am 2020; 31(1):1-13.
9) Christine C, Dolk H, Platt MJ, Colver A, Prasauskiene A, Krageloh-Mann I; SCPR Collaborative Group. Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol Suppl 2007; 109:35-8.
10) Krageloh-Mann I. Cerebral palsy and related movement disorders. En: Arzimanoglou A, O´Hare A, Johnston MV, Ouvrier R, eds. Aicardi´s Diseases of the nervous system in childhood. 4th ed. London: Mac Keith Press, 2018:347-74.
11) Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39(4):214-23.
12) Morris C. Definition and classification of cerebral palsy: a historical perspective. Dev Med Child Neurol Suppl 2007; 109:3-7.
13) Graham D, Paget SP, Wimalasundera N. Current thinking in the health care management of children with cerebral palsy. Med J Aust 2019; 210(3):129-35.
14) Love SC, Novak I, Kentish M, Desloovere K, Heinen F, Molenaers G, et al. Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neurol 2010; 17(Suppl 2):9-37.
15) Blumetti FC, Belloti JC, Tamaoki MJ, Pinto JA. Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy. Cochrane Database Syst Rev 2019; 10(10):CD001408.
16) Novak I. Therapy for children with cerebral palsy: who, what, and how much? Dev Med Child Neurol 2020; 62(1):17.
17) Franki I, Bar-On L, Molenaers G, Van Campenhout A, Craenen K, Desloovere K, et al. Tone reduction and physical therapy: strengthening partners in treatment of children with spastic cerebral palsy. Neuropediatrics 2020; 51(2):89-104.
18) Mirska A, Kulak W, Okurowska-Zawada B, Dmitruk E. Effectiveness of multiple botulinum toxin sessions and the duration of effects in spasticity therapy in children with cerebral palsy. Childs Nerv Syst 2019; 35(1):141-7.
19) Mathevon L, Bonan I, Barnais JL, Boyer F, Dinomais M. Adjunct therapies to improve outcomes after botulinum toxin injection in children: a systematic review. Ann Phys Rehabil Med 2019; 62(4):283]90.
20) Choi JY, Kim SK, Park ES. The effect of botulinum toxin injections on gross motor function for lower limb spasticity in children with cerebral palsy. Toxins (Basel) 2019; 11(11):651.
21) Read FA, Boyd RN, Barber LA. Longitudinal assessment of gait quality in children with bilateral cerebral palsy following repeated lower limb intramuscular Botulinum toxin-A injections. Res Dev Disabil 2017; 68:35-41.
22) Gallego-Antúnez A, Rodríguez-Bonache MJ. Revisión sistemática de la eficacia del tratamiento combinado de fisioterapia junto con toxina botulínica tipo A en la espasticidad de miembros inferiores en niños con parálisis cerebral. Rehabilitación 2016; 50(2):95-107.
23) Linden O, Hagglund G, Rodby-Bousquet E, Wagner P. The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study. Acta Orthop 2019; 90:286-91.
24) Hareb F, Bertoncelli CM, Rosello O, Rampal V, Solla F. Botulinum toxin in children with cerebral palsy: an update. Neuropediatrics 2020; 51(1):1-5.
25) Aktaş E, Ömeroğlu H. Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalik Cerrahisi 2019; 30(2):155-62.
26) Yana M, Tutuola F, Westwater-Wood S, Kavlak E. The efficacy of botulinum toxin A lower limb injections in addition to physiotherapy approaches in children with cerebral palsy: a systematic review. NeuroRehabilitation 2019; 44(2):175-89.
27) Organización Mundial de la Salud. Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud: versión para la infancia y adolescencia: CIF-IA. Madrid: Ministerio de Sanidad, Política Social e Igualdad, 2011.
28) Schiariti V, Longo E, Shoshmin A, Kozhushko L, Besstrashnova Y, Król M, et al. Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy: global initiatives promoting optimal functioning. Int J Environ Res Public Health 2018; 15(9):1899.
29) Kahraman A, Seyhan K, Değer Ü, Kutlutürk S, Mutlu A. Should botulinum toxin A injections be repeated in children with cerebral palsy? A systematic review. Dev Med Child Neurol 2016; 58(9):910-7.
30) Fazzi E, Maraucci I, Torrielli S, Motta F, Lanzi G. Factors predicting the efficacy of botulinum toxin-A treatment of the lower limb in children with cerebral palsy. J Child Neurol 2005; 20(08):661-6.
31) Molenaers G, Fagard K, Van Campenhout A, Desloovere K. Botulinum toxin A treatment of the lower extremities in children with cerebral palsy. J Child Orthop 2013; 7:383-7.
32) Schasfoort F, Pangalila R, Sneekes EM, Catsman C, Becher J, Horemans H, et al. Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy. J Rehabil Med 2018; 50(8):732-42.
33) Kanovsky P, Bares M, Severa S, Richardson A. Long-term efficacy and tolerability of 4-monthly versus yearly botulinum toxin type A treatment for lower-limb spasticity in children with cerebral palsy. Dev Med Child Neurol 2009; 51(6):436-45.
34) Hastings-Ison T, Blackburn C, Rawicki B, Fahey M, Simpson P, Baker R, et al. Injection frequency of botulinum toxin A for spastic equinus: a randomized clinical trial. Dev Med Child Neurol 2016; 58(7):750-7.
35) Kang BS, Bang MS, Jung SH. Effects of botulinum toxin A therapy with electrical stimulation on spastic calf muscles in children with cerebral palsy. Am J Phys Med Rehabil 2007; 86(11):901-6.
36) Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, et al. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91(3):421-8.
37) Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop 2003; 23(3):296-301.
38) Hanlan A, Mills P, Lipson R, Finlayson H. Interdisciplinary spasticity management clinic outcomes using the Goal Attainment Scale: a retrospective chart review. J Rehabil Med 2017; 49(5):423-30.
39) Valentine J, Davidson SA, Bear N, Blair E, Paterson L, Ward R, et al. A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term Botulinum toxin type A use. BMC Pediatr 2020; 20(1):7.
40) Narayanan UG, Fehlings D, Weir S, Knights S, Kiran S, Campbell K. Initial development and validation of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Dev Med Child Neurol 2006; 48(10): 804-12.
2) Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130(5):e1285-312.
3) Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep 2020; 20(2):3.
4) Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109:8-14.
5) Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, et al. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004; 62(6):851-63.
6) Multani I, Manji J, Hastings-Ison T, Khot A, Graham K. Botulinum toxin in the management of children with cerebral palsy. Paediatr Drugs 2019; 21(4):261-81.
7) Smith LR, Pichika R, Meza RC, Gillies AR, Baliki MN, Chambers HG, et al. Contribution of extracellular matrix components to the stiffness of skeletal muscle contractures in patients with cerebral palsy. Connect Tissue Res 2021; 62(3):287-98.
8) Schwabe AL. Comprehensive care in cerebral palsy. Phys Med Rehabil Clin N Am 2020; 31(1):1-13.
9) Christine C, Dolk H, Platt MJ, Colver A, Prasauskiene A, Krageloh-Mann I; SCPR Collaborative Group. Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol Suppl 2007; 109:35-8.
10) Krageloh-Mann I. Cerebral palsy and related movement disorders. En: Arzimanoglou A, O´Hare A, Johnston MV, Ouvrier R, eds. Aicardi´s Diseases of the nervous system in childhood. 4th ed. London: Mac Keith Press, 2018:347-74.
11) Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39(4):214-23.
12) Morris C. Definition and classification of cerebral palsy: a historical perspective. Dev Med Child Neurol Suppl 2007; 109:3-7.
13) Graham D, Paget SP, Wimalasundera N. Current thinking in the health care management of children with cerebral palsy. Med J Aust 2019; 210(3):129-35.
14) Love SC, Novak I, Kentish M, Desloovere K, Heinen F, Molenaers G, et al. Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neurol 2010; 17(Suppl 2):9-37.
15) Blumetti FC, Belloti JC, Tamaoki MJ, Pinto JA. Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy. Cochrane Database Syst Rev 2019; 10(10):CD001408.
16) Novak I. Therapy for children with cerebral palsy: who, what, and how much? Dev Med Child Neurol 2020; 62(1):17.
17) Franki I, Bar-On L, Molenaers G, Van Campenhout A, Craenen K, Desloovere K, et al. Tone reduction and physical therapy: strengthening partners in treatment of children with spastic cerebral palsy. Neuropediatrics 2020; 51(2):89-104.
18) Mirska A, Kulak W, Okurowska-Zawada B, Dmitruk E. Effectiveness of multiple botulinum toxin sessions and the duration of effects in spasticity therapy in children with cerebral palsy. Childs Nerv Syst 2019; 35(1):141-7.
19) Mathevon L, Bonan I, Barnais JL, Boyer F, Dinomais M. Adjunct therapies to improve outcomes after botulinum toxin injection in children: a systematic review. Ann Phys Rehabil Med 2019; 62(4):283]90.
20) Choi JY, Kim SK, Park ES. The effect of botulinum toxin injections on gross motor function for lower limb spasticity in children with cerebral palsy. Toxins (Basel) 2019; 11(11):651.
21) Read FA, Boyd RN, Barber LA. Longitudinal assessment of gait quality in children with bilateral cerebral palsy following repeated lower limb intramuscular Botulinum toxin-A injections. Res Dev Disabil 2017; 68:35-41.
22) Gallego-Antúnez A, Rodríguez-Bonache MJ. Revisión sistemática de la eficacia del tratamiento combinado de fisioterapia junto con toxina botulínica tipo A en la espasticidad de miembros inferiores en niños con parálisis cerebral. Rehabilitación 2016; 50(2):95-107.
23) Linden O, Hagglund G, Rodby-Bousquet E, Wagner P. The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study. Acta Orthop 2019; 90:286-91.
24) Hareb F, Bertoncelli CM, Rosello O, Rampal V, Solla F. Botulinum toxin in children with cerebral palsy: an update. Neuropediatrics 2020; 51(1):1-5.
25) Aktaş E, Ömeroğlu H. Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalik Cerrahisi 2019; 30(2):155-62.
26) Yana M, Tutuola F, Westwater-Wood S, Kavlak E. The efficacy of botulinum toxin A lower limb injections in addition to physiotherapy approaches in children with cerebral palsy: a systematic review. NeuroRehabilitation 2019; 44(2):175-89.
27) Organización Mundial de la Salud. Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud: versión para la infancia y adolescencia: CIF-IA. Madrid: Ministerio de Sanidad, Política Social e Igualdad, 2011.
28) Schiariti V, Longo E, Shoshmin A, Kozhushko L, Besstrashnova Y, Król M, et al. Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy: global initiatives promoting optimal functioning. Int J Environ Res Public Health 2018; 15(9):1899.
29) Kahraman A, Seyhan K, Değer Ü, Kutlutürk S, Mutlu A. Should botulinum toxin A injections be repeated in children with cerebral palsy? A systematic review. Dev Med Child Neurol 2016; 58(9):910-7.
30) Fazzi E, Maraucci I, Torrielli S, Motta F, Lanzi G. Factors predicting the efficacy of botulinum toxin-A treatment of the lower limb in children with cerebral palsy. J Child Neurol 2005; 20(08):661-6.
31) Molenaers G, Fagard K, Van Campenhout A, Desloovere K. Botulinum toxin A treatment of the lower extremities in children with cerebral palsy. J Child Orthop 2013; 7:383-7.
32) Schasfoort F, Pangalila R, Sneekes EM, Catsman C, Becher J, Horemans H, et al. Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy. J Rehabil Med 2018; 50(8):732-42.
33) Kanovsky P, Bares M, Severa S, Richardson A. Long-term efficacy and tolerability of 4-monthly versus yearly botulinum toxin type A treatment for lower-limb spasticity in children with cerebral palsy. Dev Med Child Neurol 2009; 51(6):436-45.
34) Hastings-Ison T, Blackburn C, Rawicki B, Fahey M, Simpson P, Baker R, et al. Injection frequency of botulinum toxin A for spastic equinus: a randomized clinical trial. Dev Med Child Neurol 2016; 58(7):750-7.
35) Kang BS, Bang MS, Jung SH. Effects of botulinum toxin A therapy with electrical stimulation on spastic calf muscles in children with cerebral palsy. Am J Phys Med Rehabil 2007; 86(11):901-6.
36) Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, et al. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91(3):421-8.
37) Read HS, Hazlewood ME, Hillman SJ, Prescott RJ, Robb JE. Edinburgh visual gait score for use in cerebral palsy. J Pediatr Orthop 2003; 23(3):296-301.
38) Hanlan A, Mills P, Lipson R, Finlayson H. Interdisciplinary spasticity management clinic outcomes using the Goal Attainment Scale: a retrospective chart review. J Rehabil Med 2017; 49(5):423-30.
39) Valentine J, Davidson SA, Bear N, Blair E, Paterson L, Ward R, et al. A prospective study investigating gross motor function of children with cerebral palsy and GMFCS level II after long-term Botulinum toxin type A use. BMC Pediatr 2020; 20(1):7.
40) Narayanan UG, Fehlings D, Weir S, Knights S, Kiran S, Campbell K. Initial development and validation of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Dev Med Child Neurol 2006; 48(10): 804-12.
Publicado
2021-09-15
Cómo citar
1.
Cerisola A, Borderre M, Carranza F, Cuadro C, Cures S, Quintela L, Vázquez M, Suárez E, Bacchetta L. Tratamiento con toxina botulínica en niños con parálisis cerebral espástica. Rev. Méd. Urug. [Internet]. 15 de septiembre de 2021 [citado 23 de abril de 2024];37(3):e37303. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/747
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