Priorities and Goals of Botulinum Toxin A Treatment in Cerebral Palsy

Klochkova O.A.; Kurenkov A.L.

doi:https://doi.org/10.17116/jnevro2019119021118

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Abstract:

Botulinum toxin A (BTA) injections are an effective method of spasticity treatment in cerebral palsy (CP) but still there are a lot of questions about the selection of target muscles. The article summarizes currently accepted approaches to the goal setting and prioritizing in CP botulinum toxin therapy according to the form of CP, GMFCS level, age, spasticity level and other factors. The authors discuss the Goal Attainment Scale (GAS) and its possibilities in the BTA injections planning and evaluation of the results. Attention is also paid to the «key muscle concept» in the multilevel spasticity treatment in CP and the additional factors that can influence the effectiveness of injections. The above approaches to the detection of patients’ problems and setting of BTA treatment goals can help to prevent serious mistakes and disappointment in this effective method of treatment.

Keywords:

cerebral palsy

spasticity

botulinum toxin A

botulinum toxin treatment

Goal Attainment Scale

GMFCS

multilevel injections

Authors:

Klochkova O.A.

FGBU "Nauchnyĭ tsentr zdorov'ia deteĭ" RAMN

Kurenkov A.L.

Nauchnyĭ tsentr zdorov'ia deteĭ RAMN

SPIN RSCI: 8579-3765
Scopus AuthorID: 6603634903
ORCID: 0000-0002-7269-9100

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References:

Scott AB. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology. 1980;87:1044-1049.
Strobl W, Theologis T, Brunner R, Kocer S, Viehweger E, Pascual-Pascual I, Placzek R. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel). 2015;7(5):1629-1648. https://doi.org/10.3390/toxins7051629
Tilton AH. Evidence-based review of safety and efficacy in cerebral palsy. Toxicon. 2015;107(Pt A):105-108. https://doi.org/10.1016/j.toxicon.2015.09.020
Delgado MR, Hirtz D, Aisen M, Ashwal S, Fehlings DL, McLaughlin J, Morrison LA, Shrader MW, Tilton A,Vargus-Adams J. Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010;74(4):336-343. https://doi.org/10.1212/WNL.0b013e3181cbcd2f
Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55(10):885-910. https://doi.org/10.1111/dmcn.12246
Heinen F, Desloovere K, Schroeder AS, Berweck S, Borggraefe I, van Campenhout A, Andersen GL, Aydin R, Becher JG, Bernert G, Caballero IM, Carr L, Valayer EC, Desiato MT, Fairhurst C, Filipetti P, Hassink RI, Hustedt U, Jozwiak M, Kocer SI, Kolanowski E, Krägeloh-Mann I, Kutlay S, Mäenpää H, Mall V, McArthur P, Morel E, Papavassiliou A, Pascual-Pascual I, Pedersen SA, Plasschaert FS, van der Ploeg I, Remy-Neris O, Renders A, Di Rosa G, Steinlin M, Tedroff K, Valls JV, Viehweger E, Molenaers G. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol. 2010;14:45-66. https://doi.org/10.1016/j.ejpn.2009.09.005
rosminzdrav.ru [internet]. Instruktsiya po meditsinskomu primeneniyu lekarstvennogo preparata botoks. Aktivna na 26.11.18. Dostupno po: http://grls.rosminzdrav.ru/GRLS.aspx?RegNumber=&MnnR=&lf=&TradeNmR=%d0%91%d0%be%d1%82%d0%be%d0%ba%d1%81&OwnerName=&MnfOrg=&MnfOrgCountry=&isfs=0&isND=-1®type=&pageSize=10&order=RegDate&orderType=desc&pageNum=1
rosminzdrav.ru [internet]. Instruktsiya po meditsinskomu primeneniyu lekarstvennogo preparata Kseomin. Aktivna na 26.11.18. Dostupno po: http://grls.rosminzdrav.ru/GRLS.aspx?RegNumber=&MnnR=&lf=&TradeNmR=%d0%9a%d1%81%d0%b5%d0%be%d0%bc%d0%b8%d0%bd&OwnerName=&MnfOrg=&MnfOrgCountry=&isfs=0&isND=-1®type=&pageSize=10&order=RegDate&orderType=desc&pageNum=1
rosminzdrav.ru [internet]. Instruktsiya po meditsinskomu primeneniyu lekarstvennogo preparata disport. Aktivna na 26.11.18. Dostupno po: http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=bff52ce8-87be-4b4f-ae9a-7f387bf0d4bb&t=
Klochkova OA, Kurenkov AL, Karimova KM, Bursagova BI, Namazova-Baranova LS, Mamedyarov AM, Kuzenkova LM, Tardova IM, Fal’kovskiy IV, Dontzov OG, Ryzhenkov MA, Zmanovskaya VA, Butorina MN, Pavlova OL, Harlamova NN, Dankov DM, Levitina EV, Popkov DA, Ryabykh SO, Medvedeva SN, Gubina EB, Vladykina LN, Kenis VM, Kiseleva TI, Krasavina DA, Vasil’eva ON, Nosko AS, Zykov VP, Michnovich VI, Belogorova TA, Rychkova LV. Multilevel botulinum Toxin A (Abobotulinum Toxin A) injections in spastic forms of cerebral palsy: retrospective analysis of 8 russian centers experience. Pediatric Pharmacology. 2016;13(3):259-269. (In Russ.) https://doi.org/10.15690/pf.v13i3.1576
Fehlings D, Novak I, Berweck S, Hoare B, Stott NS, Russo RN. Cerebral Palsy Institute. Botulinum toxin assessment, intervention and follow-up for paediatric upper limb hypertonicity: international consensus statement. Eur J Neurol. 2010;17(suppl 2):38-56. https://doi.org/10.1111/j.1468-1331.2010.03127.x
Hoare BJ, Wallen MA, Imms C, Villanueva E, Rawicki HB, Carey L. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE). Cochrane Database Syst Rev. 2010;(1):CD003469. https://doi.org/10.1002/14651858.cd003469.pub4
Kurenkov AL, Klochkova OA, Zmanovskaya VA, Falkovskiy IV, Kenis VM, Vladykina LN, Krasavina DA, Nosko AS, Rychkova LV, Karimova HM, Bursagova BI, Namazova-Baranova LS, Mamedyarov AM, Kuzenkova LM, Dontzov OG, Ryzhenkov MA, Butorina MN, Pavlova OL, Harlamova NN, Dankov DM, Levitina EV, Popkov DA, Ryabykh SO, Medvedeva SN, Gubina EB, Agranovich OV, Kiseleva TI, Vasileva ON, Zykov VP, Mihnovich VI, Belogorova TA. The first Russian consensus on the multilevel AbobotulinumtoxinA injections in spastic forms of cerebral palsy. Zhurnal Nevrologii i Psihiatrii im. S.S. Korsakova. 2016;116(11):121-130. (In Russ.) https://doi.org/10.17116/jnevro2016116111121-130
Gracies JM, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the tardieu scale for assessing spasticity in children with cerebral palsy. Arch Phys Med Rehabil. 2010;91:421-428.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206-207.
Baranov AA, Namazova-Baranova LS, Kurenkov AL, Klochkova OA, Karimova HM, Mamed’yarov AM, Zherdev KV, Kuzenkova LM, Bursagova BI. Kompleksnaya ocenka dvigatel’nyh funkcij u pacientov s detskim cerebral’nym paralichom. Ucheb.-metod. posobie. Federal’noe gos. byudzhetnoe nauch. uchrezhdenie Nauch centr zdorov’ya detej. M.: Pediatr; 2014.
Hustedt U. Botulinumtoxin bei spastischen Bewegungsstörungen: ultraschallgestützte Technik und Anwendung. Marburg: KVM; 2011.
Graham HK, Rosenbaum P, Paneth N, Dan B, Lin JP, Damiano DL, Becher JG, Gaebler-Spira D, Colver A, Reddihough DS, Crompton KE, Lieber RL. Cerebral palsy. Nat Rev Dis Primers. 2016;2:15082. https://doi.org/10.1038/nrdp.2015.82
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-223. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
Hanna SE, Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol. 2009;51(4):295-302.
Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R, Reddihough D, Graham HK. Hip displacement in cerebral palsy. J Bone Joint Surg Am. 2006;88(1):121-129. https://doi.org/10.2106/JBJS.E.00071
Kiresuk TJ, Sherman RE. Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal. 1968;4:443-453. https://doi.org/10.1007/BF01530764
Turner-Stokes L. Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil. 2009;23(4):362-370. https://doi.org/10.1177/0269215508101742
Löwing K, Thews K, Haglund-Åkerlind Y, Gutierrez-Farewik EM. Effects of botulinum toxin-A and goal-directed physiotherapy in children with cerebral palsy GMFCS levels I & II. Phys Occup Ther Pediatr. 2017;37(3):268-282. https://doi.org/10.3109/01942638.2016.1150384
Tilton A, Russman B, Aydin R, Dincer U, Escobar RG, Kutlay S, Lipczyk Z, Velez JC, Grandoulier A-S, Tse A, Picaut P, Delgado MR. AbobotulinumtoxinA (Dysport) improves function according to goal attainment in children with dynamic equinus due to cerebral palsy. J Child Neurol. 2017;32(5):482-487. https://doi.org/10.1177/0883073816686910
Janette McDougall, Gillian King. Goal Attainment Scaling: Description, Utility, and Applications in Pediatric Therapy Services. 2007. McDougall & King. http://elearning.canchild.ca/dcd_pt_workshop/assets/planning-interventions-goals/goal-attainment-scaling.pdf
Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P, Zakine B. Upper limb international spasticity study: rationale and protocol for a large, international, multicentre prospective cohort study investigating management and goal attainment following treatment with botulinum toxin A in real-life clinical practice. BMJ Open. 2013;3(3). pii: e002230. https://doi.org/10.1136/bmjopen-2012-002230
Hägglund G, Wagner P. Development of spasticity with age in a total population of children with cerebral palsy. BMC Musculoskelet Disord. 2008;9:150. https://doi.org/10.1186/1471-2474-9-150
Klochkova OA, Kurenkov AL, Namazova-Baranova LS, Mamedyarov AM, Karimova HM, Kuznetsova MA. The Concept of «Key Muscles» and the Early Onset of Botulinum Therapy in Spastic Forms of Cerebral Palsy. Voprosy Sovremennoi Pediatrii — Current Pediatrics. 2017;16(1):39-48. (In Russ.) https://doi.org/10.15690/vsp.v16i1.1693
Placzek R, Salem KH, Meiss LA, Siebold D, Drescher W. The key-muscle concept: a long-term low-dose injection strategy for botulinum toxin A treatment in cerebral palsy. Acta Orthop Belg. 2012;78(1):111-116.
Paget SP, Swinney CM, Burton KLO, Bau K, O’Flaherty SJ. Systemic adverse events after botulinum neurotoxin A injections in children with cerebral palsy. Dev Med Child Neurol. 2018;60(11):1172-1177.
NeuroKids. Child neurology workbook. Ed. Heinen F. Stuttgart: Kohlhammer; 2017.
Fitoussi F, Diop A, Maurel N, Laasel M, Ilharreborde B, Pennecot GF. Upper limb motion analysis in children with hemiplegic cerebral palsy: Proximal kinematic changes after distal botulinum toxin or surgical treatments. J Child Orthop. 2011;5:363-370. https://doi.org/10.1007/s11832-011-0365-z
Delgado MR, Bonikowski M, Carranza J, Dabrowski E, Matthews D, Russman B, Tilton A, Velez JC, Grandoulier AS, Picaut P. Safety and efficacy of repeat open-label AbobotulinumtoxinA treatment in pediatric cerebral palsy. J Child Neurol. 2017;32(13):1058-1064. https://doi.org/10.1177/0883073817729918