A Clinical Study On Botulinum Toxin A Injection For Spastic Cerebral Palsy Children

Objective:To evaluate the clinical value of Botulinum toxin A injection for spastic cerebral palsy children.Methods:The study was divided into two parts.Part one: This part is to evaluate the clinical value of Botulinum toxin A injection for lower limbs spasticity cerebral palsy children. From July 2008 to July 2010, 200 cerebral palsy children (male 103, female 97, mean age 48.47±15.36 months) with lower limbs spasticity in our hospital was chose into this study. Divide 200 patients into 2 groups evenly, a group with Botulinum toxin A injection (injection group) and a group with rehabilitation treatment section (control group). For the injection group, Botulinum toxin A was accurately injected into the spasticity muscle. Patients in the injection group continued rehabilitation training the day after injection. For all patients, before treatment and one week, two weeks, four weeks, eight weeks and twelve weeks after treatment, muscle spasticity and movement and function were evaluated by using Modified Ashworth Scale, Gross Motor Function Measure and Physician Rating Scale respectively.Part two: This part is to evaluate the clinical value of ultrasound-guided Botulinum toxin A injection for upper limb spasticity in cerebral palsy children. From July 2009 to July 2010 , 20 cerebral palsy children (male 11, female 9, mean age 46.60±13.05 months) with upper limb spasticity in our hospital was chose into this study. Divide 20 patients into 2 groups evenly, a group with Botulinum toxin A injection (injection group) and a group with rehabilitation treatment section (control group). For the injection group,under the guidance of ultrasound , Botulinum toxin A was accurately injected into the spasticity muscle of upper limb. Patients in the injection group continued rehabilitation training the day after injection. For all patients, before treatment and one week, two weeks, four weeks, eight weeks and twelve weeks after treatment, muscle spasticity and upper limb movement and function were evaluated by using Modified Ashworth Scale and Fugl-Meyer assessment scale respectively.Results:1,Part one: The improvement of muscle spasticity and scores of movement and function after treatment in the injection group were better than before injection (P<0.01). The therapeutic effects in the injection group were better than the control group. The scores of Modified Ashworth Scale, Gross Motor Function Measure and Physician Rating Scale four weeks after injection were better than the same time in the control group, and the differences between the two groups were statistically significant (P<0.01).2,Part two: The improvement of muscle spasticity and scores of the upper limb movement and function after treatment in the injection group were better than before injection (P<0.01). The improvement of muscle spasticity was best two weeks after injection. The score of Modified Ashworth Scale two weeks after injection was better than the same time in the control group, and the difference between the two scores was statistically significant (P<0.001). The scores of Fugl-Meyer assessment Scale in the injection group were better than the control group, and the differences between the two groups were statistically significant (P<0.01).Conclusions:1,Botulinum toxin A injection could reduce spasm quickly and effectively. Compared with simple rehabilitation training, Botulinum toxin A injection in combination with rehabilitation training could make significantly greater improvement in movement and function, shorten the period of treatment.2,Under ultrasound guide, the Botulinum toxin A injection positioning technology in the treatment of upper limb spasticity in cerebral palsy children has the advantages of secure positioning and evident effect.