Kurenkov A L, Kuzenkova L M, Bursagova B I, Klochkova O A, Chernikov V V, Kuznetsova M A, Ashrafova U S, Kuprianova O S
National Medical Research Center for Children's Health, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(7):68-77. doi: 10.17116/jnevro202012007168.
A retrospective analysis of the experience of using Incobotulinum toxin A injections for the treatment of spasticity in children with cerebral palsy (CP).
One hundred and eighty-five children with spastic forms of CP, including 114 boys (61,6%), were studied. The average age of the patients was 3,8±2,5 years; the average weight was 14,2±6,9. The patients received injections of Incobotulinum toxin A according to registered indications or recommendations of a consultation of specialists and voluntary informed consent of the patient's representative. At least 1 point decrease of muscle tone according to the modified Ashworth scale was used as a criterion of the antispastic effect of Incobotulinum toxin A.
The total dose of Incobotulinum toxin A for the whole group of patients with CP was 154,5±67,7 U and 11,6±4,7 U per kg/body weight. The gracilis muscle (65,4% of cases, 95%CI 58,1-72,2) and the gastrocnemius muscle (49,4% of cases, 95%CI 41,8-56,6) were the most frequently injected targets in the lower extremities, and the pronator teres muscle (58,9% of cases, 95%CI 51,5-66,1) - in the upper extremities. Adverse events were observed in 13 patients (7,0%). They were mild in 9 patients and moderate in 4 patients.
Our data confirmed the effectiveness and safety of Incobotulinum toxin A injections in spastic CP. The calculated average doses of Incobotulinum toxin A for target muscles and the frequency of different spasticity patterns could serve as a reference for the botulinum therapy planning.
回顾性分析使用A型肉毒杆菌素(Incobotulinum toxin A)注射治疗脑瘫(CP)患儿痉挛的经验。
研究了185例痉挛型CP患儿,其中包括114名男孩(61.6%)。患者的平均年龄为3.8±2.5岁;平均体重为14.2±6.9。患者根据注册适应症、专家会诊建议以及患者代表的自愿知情同意接受A型肉毒杆菌素注射。根据改良Ashworth量表,肌张力至少降低1分作为A型肉毒杆菌素抗痉挛效果的标准。
CP患者全组的A型肉毒杆菌素总剂量为154.5±67.7单位,每公斤体重11.6±4.7单位。下肢最常注射的部位是股薄肌(65.4%的病例,95%置信区间58.1 - 72.2)和腓肠肌(49.4%的病例,95%置信区间41.8 - 56.6),上肢是旋前圆肌(58.9%的病例,95%置信区间51.5 - 66.1)。13例患者(7.0%)出现不良事件。9例为轻度,4例为中度。
我们的数据证实了A型肉毒杆菌素注射治疗痉挛型CP的有效性和安全性。计算出的目标肌肉A型肉毒杆菌素平均剂量以及不同痉挛模式的频率可为肉毒杆菌治疗方案的制定提供参考。