Klochkova O A, Kurenkov A L, Karimova H M, Namazova-Baranova L S, Memedyarov A M, Kuzenkova L M, Bursagova B I
Vestn Ross Akad Med Nauk. 2014(9-10):57-63. doi: 10.15690/vramn.v69i9-10.1132.
Our aim was to analyze the dosages of Abobotulinum toxin A used for each muscle in the clinically effective and safe repeated multilevel injections in CP children, and the intervals between injections.
Retrospective analysis of 229 injection sessions into 359 muscles of the upper and 361 muscles of the lower extremities in 133 children (2-18 years) with spastic CP. Analysis included only patients who were injected for the first time and demonstrated decrease of spasticity in injected muscles according to modified Ashworth and/or Tardieu scales without significant side effects 2-4 weeks after injections. Motor deficit according to GMFCS was: GMFCS I--16(12%) children, GMFCS II--26 (19.6%), GMFCS III--43 (32.3%), GMFCS IV--30 (22.6%), GMFCS V--18 (13.5%). Repeated injections (up to 5 sessions) were done in 59 children. Maximum follow-up perion was 22 months. 40 patients (30.1%) had one-sided injections, 93 (69.9%)--two-sided, 125 (94%)--multilevel injections.
We presented minimal and maximal dosages, interquartile ranges for each injected muscle, also "off-label" and our proposition of per-segment calculation of dosages in multilevel injections in CR. We also demonstrated the stability of intervals between repeated injections and dosages per kg in a patient. These results are compared with the official Russian and international recommendations of BTX-A treatment for children.
We presented our experience of BTX-A dosages calculation for the spastic CP treatment which could be used as a recommendation and guide for the multilevel injections treatment according to the aims of rehabilitation, spasticity level, muscle size and motor deficit of a concrete patient.
我们的目的是分析在对痉挛型脑性瘫痪（CP）患儿进行临床有效且安全的重复多级注射时，用于每块肌肉的阿柏西普肉毒素A的剂量，以及注射间隔时间。
对133例2至18岁痉挛型CP患儿上肢的359块肌肉和下肢的361块肌肉进行的229次注射疗程进行回顾性分析。分析仅纳入首次注射且在注射后2至4周根据改良Ashworth和/或Tardieu量表显示注射肌肉痉挛程度降低且无明显副作用的患者。根据 Gross Motor Function Classification System（GMFCS）评估的运动功能障碍情况为：GMFCS I级——16例（12%）患儿，GMFCS II级——26例（19.6%），GMFCS III级——43例（32.3%），GMFCS IV级——30例（22.6%），GMFCS V级——18例（13.5%）。59例患儿进行了重复注射（最多5个疗程）。最长随访期为22个月。40例患者（30.1%）进行了单侧注射，93例（69.9%）进行了双侧注射，125例（94%）进行了多级注射。
我们列出了每块注射肌肉的最小和最大剂量、四分位间距，还列出了“超说明书用药”情况以及我们对CR中多级注射按节段计算剂量的建议。我们还展示了患者重复注射间隔时间和每千克剂量的稳定性。将这些结果与俄罗斯官方和国际上关于儿童BTX - A治疗的建议进行了比较。
我们展示了在痉挛型CP治疗中计算BTX - A剂量的经验，可作为根据具体患者的康复目标、痉挛程度、肌肉大小和运动功能障碍情况进行多级注射治疗的建议和指导。
