Croix-rouge française - Centre Médico Chirurgical de Réadaptation des Massues, Lyon, France.
Eur J Paediatr Neurol. 2011 Sep;15(5):439-48. doi: 10.1016/j.ejpn.2010.04.006. Epub 2011 Jul 13.
Dystonia and spasticity are common symptoms in children with Cerebral Palsy (CP), whose management is a challenge to overcome in order to enable the harmonized development of motor function during growth.
To describe botulinum toxin A (BTX-A) use and efficacy as a treatment of focal spasticity in CP children in France.
This prospective observational study included 282 CP children mostly administered according to French standards with BTX-A in lower limbs. Realistic therapeutic objectives were set with parents and children together before treatment initiation and assessed using the Visual Analogue Scale (VAS). Child management was recorded and the efficacy of injections was assessed during a 12-month follow-up period by physicians (Modified Ashworth Scale, joint range of motion, Physician Rating Scale, Gillette Functional Assessment Questionnaire and Gross Motor Function Measure-66) and by patients/parents (Visual Analogue Scale).
BTX-A treatment was administered in different muscle localizations at once and at doses higher than those recommended by the French Health Authorities. Children were treated in parallel by physiotherapy, casts and ortheses. Injections reduced spasticity and improved joint range of motion, gait pattern and movement capacity. Pain was reduced after injections. BTX-A administration was safe: no botulism-like case was reported. The log of injected children who were not included in the study suggested that a large population could benefit from BTX-A management.
We showed here the major input of BTX-A injections in the management of spasticity in CP children. The results are in favor of the use of BTX-A as conservative safe and efficient treatment of spasticity in children, which enables functional improvement as well as pain relief.
脑瘫（CP）患儿常出现肌肉痉挛和运动障碍，对其进行管理是一个挑战，目的是在患儿生长过程中促进运动功能协调发展。
描述法国 CP 儿童使用肉毒毒素 A（BTX-A）治疗局部痉挛的情况和疗效。
本前瞻性观察性研究纳入了 282 名 CP 患儿，他们主要按照法国标准接受下肢 BTX-A 治疗。在治疗开始前，与患儿及其家长共同设定切合实际的治疗目标，并采用视觉模拟评分法（VAS）进行评估。记录患儿管理情况，在 12 个月的随访期间，由医生（改良 Ashworth 量表、关节活动范围、医生评定量表、吉尔伯特功能评估问卷和粗大运动功能测试-66）和患儿/家长（VAS）评估注射疗效。
BTX-A 治疗时同时对多个肌肉部位进行注射，剂量高于法国卫生当局推荐的剂量。同时对患儿进行物理治疗、石膏固定和矫形器治疗。注射可降低肌肉痉挛程度，改善关节活动范围、步态模式和运动能力。注射后疼痛减轻。BTX-A 治疗安全，无类肉毒中毒病例报告。未纳入研究的注射患儿记录表明，大量患儿可能从 BTX-A 治疗中获益。
本研究表明 BTX-A 注射在 CP 儿童痉挛管理中发挥了重要作用。结果表明，BTX-A 是一种安全有效的痉挛保守治疗方法，可改善功能，缓解疼痛。
