Calderón-González R, Calderón-Sepúlveda R F
Centro Neurológico para Niños y Adolescentes. Hospital San José Tec de Monterrey, Monterrey, 64710, México.
Rev Neurol. 2002;34(1):52-9.
A review of the pathophysiological and developmental basis, measurement scales and the usefulness of botulinum toxin A injections in selected muscles for the treatment of spasticity in children with cerebral palsy.
Cerebral palsy is the most common cause of spasticity in children. The increase in muscle length is achieved through the addition of sarcomeres in series at the level of the muscle tendinous junction. The regulation of the number of sarcomeres seems to be determined by the lengthening of the muscle. The muscle contracture is a shortening of the length of a muscle as a result of a decrease in the number of sarcomeres. Spasticity and motor function assessment scales used in children with cerebral palsy: a) Modified Ashworth scale for the assessment of spasticity; b) modified Tardieu scale for the assessment of dynamic muscle length; c) muscle spasms frequency scale; d) modified Medical Research Council scale for muscle strength; e) hip adductor muscle tone scale; f) global pain scale with affective facial expression represented in a drawing; g) goniometric measurement of the joint range of movement; h) Palisano gross motor function measure; i) observational video gait analysis scale. Recommended guidelines for dosing the botulinum toxin A: 1. Total maximum dose administered per visit up to 15 U/kg or a total of 400 U; 2. Dose range of large muscles 3 to 6 U/kg per visit; 3. Dose range of small muscles 1 to 3 U/kg per visit; 4. Maximum dose per injection site: 50 U dividing the total planned unit dose/muscle into equal amounts/injection site; 5. Frequency: no more than one injection every 3 months, frequently once every 6 or more months.
Botulinum toxin A injection is a well tolerated, safe and effective procedure in the treatment of children with spastic cerebral palsy.
综述肉毒杆菌毒素A注射于特定肌肉治疗小儿脑性瘫痪痉挛状态的病理生理及发育基础、测量量表及其效用。
脑性瘫痪是小儿痉挛状态最常见的病因。肌肉长度的增加是通过在肌腱连接水平串联增加肌节来实现的。肌节数量的调节似乎由肌肉的拉长所决定。肌肉挛缩是由于肌节数量减少导致肌肉长度缩短。用于评估脑性瘫痪患儿痉挛状态和运动功能的量表：a）改良Ashworth量表用于评估痉挛状态；b）改良Tardieu量表用于评估动态肌肉长度；c）肌肉痉挛频率量表；d）改良医学研究委员会肌力量表；e）髋内收肌张力量表；f）以绘图形式呈现带有情感面部表情的整体疼痛量表；g）关节活动范围的量角器测量；h）Palisano粗大运动功能测量；i）观察性视频步态分析量表。推荐的肉毒杆菌毒素A给药指南：1. 每次就诊的最大总剂量可达15 U/kg或总计400 U；2. 大肌肉的剂量范围为每次就诊3至6 U/kg；3. 小肌肉的剂量范围为每次就诊1至3 U/kg；4. 每个注射部位的最大剂量：50 U，将计划的总单位剂量/肌肉平均分配到各个注射部位；5. 频率：每3个月不超过1次注射，通常每6个月或更长时间1次。
肉毒杆菌毒素A注射治疗痉挛型小儿脑性瘫痪耐受性良好、安全且有效。
