The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Kurenkov A.L.

National Medical Research Center for Children’s Health

Klochkova O.A.

National Medical Research Center for Children’s Health

Kuzenkova L.M.

National Medical Research Center for Children’s Health

Bursagova B.I.

National Medical Research Center for Children’s Health

Karimova Kh.M.

National Medical Research Center for Children’s Health

Multilevel botulinum toxin treatment in severe spastic forms of cerebral palsy (GMFCS IV—V)

Authors:

Kurenkov A.L., Klochkova O.A., Kuzenkova L.M., Bursagova B.I., Karimova Kh.M.

More about the authors

Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(12): 57‑66

DOI: 10.17116/jnevro202012012157

Views: 1816

Downloaded: 71

Download PDF (RU)
Contact the author
Table of contents

To cite this article:

Kurenkov AL, Klochkova OA, Kuzenkova LM, Bursagova BI, Karimova KhM. Multilevel botulinum toxin treatment in severe spastic forms of cerebral palsy (GMFCS IV—V). S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(12):57‑66. (In Russ.)
https://doi.org/10.17116/jnevro202012012157

 
МСФ на ЯМ
Close metadata
Recommended articles:
Safety and effi­cacy of Rela­tox in comparison with Dysport in the treatment of focal spasticity of the upper limb in patients after stroke and traumatic brain injury (results of a prospective simple blind randomized comparative study in para­llel groups). S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(12):79-85
Abobotulinumtoxin A inje­ctions for the chro­nic sialorrhea correction in children: Russian retrospective multicenter study. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(1):53-61
Aica­rdi—Goutieres syndrome type 6 asso­ciated with a compound hete­rozygous variant in ADAR: a first case report in the Russian popu­lation. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(1):131-138
Sequential use of botu­linum toxin A and bovhyaluronidase azoximer in the correction of post-stroke spasticity. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(2):80-85
Intrathecal baclofen therapy: a 30-year expe­rience. Burdenko's Journal of Neurosurgery. 2024;(3):96-102
Five-year follow-up after neurosurgery complicated by facial neuropathy. Burdenko's Journal of Neurosurgery. 2024;(4):50-55
Asse­ssment of the effe­ctiveness of preparation of the ante­rior abdo­minal wall for the purpose of plasty of its defe­cts in an expe­rimental. Russian Journal of Operative Surgery and Clinical Anatomy. 2024;(3):14-21
Pote­ntial applications of botu­linum toxin formulations in addressing postnasal syndrome. Russian Rhinology. 2024;(4):301-307
Changes in muscle tone after electrotherapy in patients suffering from chro­nic migraine and cervicalgia. Problems of Balneology, Physiotherapy and Exercise Therapy. 2024;(6-2):96-101
Sele­ctive dorsal rhizotomy in children with here­ditary spastic para­plegia. Burdenko's Journal of Neurosurgery. 2025;(1):46-51

OBJECTIVE

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.

MATERIAL AND METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords:

cerebral palsy
spasticity
botulinum toxin
AbobotulinumtoxinA
non-ambulant children
GMFCS IV
GMFCS V

Authors:

Kurenkov A.L.

National Medical Research Center for Children’s Health

Klochkova O.A.

National Medical Research Center for Children’s Health

Kuzenkova L.M.

National Medical Research Center for Children’s Health

Bursagova B.I.

National Medical Research Center for Children’s Health

Karimova Kh.M.

National Medical Research Center for Children’s Health

Received:

16.10.2020

Accepted:

09.11.2020

List of references:

  1. Strobl W, Theologis T, Brunner R, et al. 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
  2. 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
  3. Palisano R, Rosenbaum P, Walter S, et al. 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
  4. Klochkova OA, Kurenkov AL. Priorities and goals of botulinum toxin A treatment in cerebral palsy. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2019;119(2):118-124. (In Russ.). https://doi.org/10.17116/jnevro2019119021118
  5. Delgado MR, Tilton A, Russman B, et al. AbobotulinumtoxinA for equinus foot deformity in cerebral palsy: a randomized controlled trial. Pediatrics. 2016;137(2):e20152830. https://doi.org/10.1542/peds.2015-2830
  6. Read FA, Boyd RN, Barber LA. Longitudinal assessment of gait quality in children with bilateral cerebral palsy following repeated lower limb intramuscular Botulinum toxin-A injections. Res Dev Disabil. 2017;68:35-41.  https://doi.org/10.1016/j.ridd.2017.07.002
  7. 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
  8. Baker R, Jasinski M, Maciag-Tymecka I, et al. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study. Dev Med Child Neurol. 2002;44(10):666-675.  https://doi.org/10.1017/s0012162201002730
  9. Tilton A, Russman B, Aydin R, et al. 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
  10. Novak I, Morgan C, Fahey M, et al. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020;20(2):3.  https://doi.org/10.1007/s11910-020-1022-z
  11. Copeland L, Edwards P, Thorley M, et al. Botulinum toxin A for nonambulatory children with cerebral palsy: a double blind randomized controlled trial. J Pediatr. 2014;165(1):140-146.e4.  https://doi.org/10.1016/j.jpeds.2014.01.050
  12. Mesterman R, Gorter JW, Harvey A, et al. Botulinum toxin type A in children and adolescents with severe cerebral palsy: a retrospective chart review. J Child Neurol. 2014;29(2):210-213.  https://doi.org/10.1177/0883073813495306
  13. Edwards P, Sakzewski L, Copeland L, et al. Safety of botulinum toxin type A for children with nonambulatory cerebral palsy. Pediatrics. 2015;136(5):895-904.  https://doi.org/10.1542/peds.2015-0749
  14. Franzén M, Hägglund G, Alriksson-Schmidt A. Treatment with Botulinum toxin A in a total population of children with cerebral palsy — a retrospective cohort registry study. BMC MusculoskeletDisord. 2017;18(1):520.  https://doi.org/10.1186/s12891-017-1880-y
  15. Gincota Bufteac E, Andersen GL, Torstein V, Jahnsen R. Cerebral palsy in Moldova: subtypes, severity and associated impairments. BMC Pediatr. 2018;19:18(1):332.  https://doi.org/10.1186/s12887-018-1305-6
  16. Khandaker G, Muhit M, Karim T, et al. Epidemiology of cerebral palsy in Bangladesh: a population-based surveillancestudy. Dev Med Child Neurol. 2019;61(5):601-609.  https://doi.org/10.1111/dmcn.14013
  17. Pak LA, Fisenko AP, Kuzenkova LM. Mul’tidistsiplinarnoe soprovozhdenie detei s detskim tserebral’nym paralichom (sovremennyi vzglyad na problemu). Moscow; 2019. (In Russ.).
  18. Pin TW, Elmasry J, Lewis J. Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review. Dev Med Child Neurol. 2013;55(4):304-313.  https://doi.org/10.1111/j.1469-8749.2012.04438.x
  19. Heinen F, Desloovere K, Schroeder AS, et al. 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
  20. Elkamil AI, Andersen GL, Skranes J, et al. Botulinum neurotoxin treatment in children with cerebral palsy: a population-based study in Norway. Eur J Paediatr Neurol. 2012;16(5):522-527.  https://doi.org/10.1016/j.ejpn.2012.01.008
  21. Multani I, Manji J, Hastings-Ison T, et al. Botulinum toxin in the management of children with cerebral palsy. Paediatr Drugs. 2019;21(4):261-281.  https://doi.org/10.1007/s40272-019-00344-8
  22. Kurenkov AL, Klochkova OA, Zmanovskaya VA, et al. The First Russian Consensus on the Multilevel Abobotulinumtoxin A Injections in Spastic Forms of Cerebral Palsy. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2016;116(11):121-130. (In Russ.). https://doi.org/10.17116/jnevro2016116111121-130
  23. Kedem P, Scher DM. Foot deformities in children with cerebral palsy. Curr Opin Pediatr. 2015;27(1):67-74.  https://doi.org/10.1097/MOP.0000000000000180
  24. Aydil S, Akpinar FM, Akpinar E, et al. Effectiveness of multilevel botulinum toxin A injection with integrated treatment program on spasticity reduction in non-ambulatory young children with cerebral palsy. Med Princ Pract. 2019;28(4):309-314.  https://doi.org/10.1159/000499369
  25. Kurenkov AL, Kuzenkova LM, Fisenko DA, et al. Changes of the spasticity patterns in children with cerebral palsy GMFCS III at the age of 2 to 12 years. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2020;120(6):36-44. (In Russ.). https://doi.org/10.17116/jnevro202012006136
  26. 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
  27. Klochkova OA, Kurenkov AL, Namazova-Baranova LS, Mamedyarov AM, Jerdev KV. General motor development and formation of hand function in patients with spastic forms of cerebral palsy on the background of botulinum therapy and complex rehabilitation. Vestnik Rossiyskoy Akademii Meditsinskih Nauk. 2013;(11):38-48. (In Russ.).
  28. Papavasiliou AS, Nikaina I, Bouros P, et al. Botulinum toxin treatment in upper limb spasticity: treatment consistency. Eur J Paediatr Neurol. 2012;16(3):237-242.  https://doi.org/10.1016/j.ejpn.2011.07.013
  29. Kurenkov AL, Klochkova OA, Karimova KM, et al. Choosing the dose of botulinum toxin type A in the treatment of spastic forms of cerebral palsy. S.S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2015;115(2):35-41. (In Russ.).
  30. Klochkova OA, Kurenkov AL, Karimova KM, et al. 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
  31. Fehlings D, Novak I, Berweck S, et al. 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
  32. Love SC, Novak I, Kentish M, et al. Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neurol. 2010;17(Suppl 2):9-37.  https://doi.org/10.1111/j.1468-1331.2010.03126.x
  33. Bakheit AM. Botulinum toxin in the management of childhood muscle spasticity: comparison of clinical practice of 17 treatment centres. Eur J Neurol. 2003;10(4):415-419.  https://doi.org/10.1046/j.1468-1331.2003.00619.x
  34. Thomason P, Rodda J, Willoughby K, Graham K. Orthopaedic assessment. In: Dan B, Mayston M, Paneth N, Rosenbloom L, eds. Cerebral palsy: science and clinical practice. London: Mac Keith Press; 2014.
  35. Shrader MW, Crea B. Hip dysplasia in children with cerebral palsy. In: Panteliadis CP, ed. Cerebral palsy: a multidisciplinary approach. 3rd ed. Springer; 2018.
  36. Vassilyadi M. Intrathecal baclofen therapy. In: Panteliadis CP, ed. Cerebral palsy: a multidisciplinary approach. 3rd ed. Springer; 2018.
  37. Pascual-Pascual SI, Pascual-Castroviejo I. Safety of botulinum toxin type A in children younger than 2 years. Eur J Paediatr Neurol. 2009;13(6):511-515.  https://doi.org/10.1016/j.ejpn.2008.10.006
  38. Druschel C, Althuizes HC, Funk JF, Placzek R. Off label use of botulinum toxin in children under two years of age: a systematic review. Toxins (Basel). 2013;5(1):60-72.  https://doi.org/10.3390/toxins5010060
  39. Klochkova OA, Kurenkov AL, Namazova-Baranova LS, et al. 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
  40. Swinney CM, Bau K, Burton KLO, et al. Severity of cerebral palsy and likelihood of adverse events after botulinum toxin A injections. Dev Med Child Neurol. 2018;60(5):498-504.  https://doi.org/10.1111/dmcn.13686
  41. O’Flaherty SJ, Janakan V, Morrow AM, et al. Adverse events and health status following botulinum toxin type A injections in children with cerebral palsy. Dev Med Child Neurol. 2011;53(2):125-130.  https://doi.org/10.1111/j.1469-8749.2010.03814.x
  42. 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. https://doi.org/10.1111/dmcn.13995

Close metadata

Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.