Kurenkov A L, Klochkova O A, Kuzenkova L M, Bursagova B I, Karimova Kh M
National Medical Research Center for Children's Health, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(12):57-66. doi: 10.17116/jnevro202012012157.
To evaluate the most typical target muscles and dosages for the first and repeated botulinum toxin A (BTA) injections in cerebral palsy (CP) patients with severe motor deficit - GMFCS IV-V.
A retrospective analysis of 677 protocols of the first and repeated Abobotulinumtoxin A (AboA) injections in 333 patients with CP GMFCS IV and V, aged 1 to 18 years, was carried out.
Ninety-seven percent of patients received multilevel injections. In the lower extremities the most typical target muscles were: m.gracilis - 221 (66.4%) patients, hip adductors - 164 (49.2%), medial hamstring - 144 (43.2%). In the upper extremities the most typical muscles were: m.pronator teres - 237 (71.2%) patients, m.biceps brachii+m.brachialis - 197 (59.2%). The total dosages of AboA and dosages for every target muscle were calculated. Several patients required high dosages (more than 30 U/kg of AboA). Higher dosages per kg were used in younger children and for repeated injections. The age-related evolution of spastic patterns was described. Adverse events were observed in 36 cases (5.3% of all injections).
The majority of patients with GMFCS IV-V required multilevel BTA injections in high dosages, especially in young age. Described selection of target muscles and dosages of AboA could be taken into account as a practical experience and reference for the BTA therapy in GMFCS IV-V patients.
评估重度运动功能障碍（GMFCS IV-V级）的脑瘫（CP）患者首次及重复注射A型肉毒毒素（BTA）时最典型的靶肌肉及剂量。
对333例年龄在1至18岁、GMFCS IV级和V级的CP患者进行的首次及重复注射阿波肉毒毒素A（AboA）的677份方案进行回顾性分析。
97%的患者接受了多节段注射。在下肢，最典型的靶肌肉为：股薄肌——221例（66.4%）患者，髋内收肌——164例（49.2%），腘绳肌内侧——144例（43.2%）。在上肢，最典型的肌肉为：旋前圆肌——237例（71.2%）患者，肱二头肌+肱肌——197例（59.2%）。计算了AboA的总剂量及每个靶肌肉的剂量。有几名患者需要高剂量（超过30 U/kg的AboA）。年龄较小的儿童及重复注射时每公斤使用的剂量更高。描述了痉挛模式的年龄相关演变。观察到36例不良事件（占所有注射的5.3%）。
大多数GMFCS IV-V级患者需要高剂量的多节段BTA注射，尤其是在幼年时。所描述的靶肌肉选择及AboA剂量可作为GMFCS IV-V级患者BTA治疗的实践经验和参考。
