Ramstad Kjersti, Karstensen Anne Bergsjø, Risberg Knut, Bergsaker David Kristian, Sommer Finn Fredrik
Barneavdelingen, seksjon for habilitering, Akershus universitetssykehus, 1474 Nordbyhagen.
Tidsskr Nor Laegeforen. 2006 Feb 9;126(4):450-2.
Botulinum toxin injection is one of the newer options in the treatment of spasticity. Treatment with botulinum toxin is always combined with physiotherapy and often with casting. We show the extent to which botulinum toxin treatment has been taken into use in our department and discuss advantages and disadvantages of giving botulinum toxin injections at local hospitals.
88 children with cerebral palsy aged 14 months to 16 years were treated with botulinum toxin between March 2000 and Dec. 2004. Injections were given in an outpatient setting, usually with the patient sedated with midazolam. Clinical examination after injection included assessment of spasticity and range of movement of joints. Motor function was videotaped. Side effects were continuously supervised.
We performed 278 treatments; during the last year (2004) 7 treatments a month on average. 59 children were injected in lower limbs only, 14 were injected in upper limbs only, and 15 were injected in both upper and lower limbs. No serious side effects were recorded, neither from the botulinum toxin itself nor related to the injection procedure.
Assessment of indications for the use of botulinum toxin is now part of the medical follow up for children with spastic cerebral palsy. Treatment can safely be given at the paediatrics department in a local hospital. Injection in superficial muscles of the lower limbs is an easy task, while injection in small muscles and deep-seated muscles requires more special skills.
肉毒杆菌毒素注射是治疗痉挛的较新方法之一。肉毒杆菌毒素治疗总是与物理治疗相结合，且常常与石膏固定相结合。我们展示了肉毒杆菌毒素治疗在我们科室的应用程度，并讨论了在当地医院进行肉毒杆菌毒素注射的优缺点。
2000年3月至2004年12月期间，对88名年龄在14个月至16岁之间的脑瘫患儿进行了肉毒杆菌毒素治疗。注射在门诊进行，通常使用咪达唑仑使患者镇静。注射后的临床检查包括对痉挛和关节活动范围的评估。对运动功能进行了录像。对副作用进行持续监测。
我们进行了278次治疗；在最后一年（2004年）平均每月7次治疗。仅对59名儿童的下肢进行了注射，仅对14名儿童的上肢进行了注射，对15名儿童的上下肢都进行了注射。未记录到严重副作用，既没有肉毒杆菌毒素本身引起的，也没有与注射程序相关的。
肉毒杆菌毒素使用指征的评估现在是痉挛性脑瘫患儿医学随访的一部分。治疗可以在当地医院的儿科安全进行。下肢浅表肌肉的注射是一项简单的任务，而小肌肉和深部肌肉的注射则需要更多特殊技能。
