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2BOTULIN THERAPY IN COMPLEX TREATMENT OF
CEREBRAL PALSY
1Madjidova Y.N., 2Azimova N.M., 3Majidova N.U., 4Allayorova A.X., 5Ayupova M.A.,
6Kakharova K.A.
1,2Tashkent Pediatric Medical Institute 3,5,6National Children's Medical Center, Tashkent, Uzbekistan 4City Clinical Psychiatric Hospital https://doi org/10.5281/zenodo. 12976568
Abstract. In this article, the authors consider the feasibility of using botulinum therapy in the complex treatment of cerebral palsy.
Keywords: cerebral palsy, botulinum therapy, complex treatment.
Relevance. Cerebral palsy (CP) G 80.-G 80.9 is a disease of the central nervous system that does not progress and is manifested by postural deformities and motor disorders. The etiology of the disease is damage to the central nervous system in the perinatal period or due to abnormal development of the brain.
Very common movement disorders in cerebral palsy occur due to muscle spasticity. Children with increased tone develop secondary problems over time, such as muscle contractures and bone deformities, which impair their function and require orthopedic surgery [1, 2, 3].
Botulinum toxin is a powerful neurotoxin that has a strong place in the treatment of spasticity in cerebral palsy. It can be used as early as 2 years of age and combined with other treatment options as the child gets older. According to the European consensus on botulinum therapy, the percentage of patients with spastic forms of cerebral palsy who are indicated for this treatment varies depending on age and gross motor function classification scale (GMFCS) scores from 50 to 75% [4,5].
Purpose: to study the role of botulinum therapy in the complex treatment of cerebral palsy.
Methods: Botulinum toxin A is a substance produced by bacteria. This toxin can be purified and used safely and effectively to reduce spasticity in specific muscle groups. The drugs used in botulinum toxin therapy work by blocking the chemical signal between nerves and muscles that causes muscles to contract or tense. It provides reliable relief from spasticity symptoms, including pain and muscle stiffness. It has been used safely in thousands of patients for over 25 years [4, 6, 7].
Injection of the gastrocnemius muscle during toe walking in a child with hemiplegia or diplegia usually results in an increase in the passive range of ankle dorsiflexion. This results in measurable improvements in gait in most children were obtained through the use of observation scales or gait analysis. These changes are noted using clinical instruments such as the modified Ashworth score and the modified Tardieu score.
However, the improvement in gait function is small in magnitude and short-term. Long-term effects of botulinum toxin therapy are achieved using additional methods such as serial casting, orthoses, night splints and intensive rehabilitation therapy.
The study was conducted at Children's National Medical Center. For the objectivity of the study, 40 case histories of patients with cerebral palsy, occurring with muscle spasticity, were selected using a random sample. The average age of the patients was 7.4±2.8 years. Based on the
Gross Motor Function Classification System scale, the studied patients were divided into 5 groups: Group I - 12.5%, Group II - 20%, Group III - 27.5%, Group IV - 15%, Group V - 25%.
Upon request, information is provided before the procedure begins. Once your doctor is ready to inject botulinum toxin, he will determine which muscle groups need to be injected. These areas are treated with alcohol and a "freezing spray" is applied. The doctor then injects botulinum toxin using a small needle. The number of injections will depend on the size of the muscle and the total number of muscles injected. The injection procedure itself will only take a few minutes. The patient cannot go to school and must be supervised by an adult on the day of botulinum therapy.
Botulinum therapy was carried out in inpatient and outpatient settings. Alternate injections were carried out. 3-4 injections are given into one muscle group. The remaining botulinum therapy injections are carried out after 3-4 days. To prevent inaccuracy of botulinum therapy injections, control was used with an ultrasound and electroneuromyographic examination apparatus [8-11]. The duration of one course varied from 9 to 13 days. After the injection, you should not lie down for at least 1 hour after the administration of botulinum toxin, or massage for a full 24 hours after botulinum therapy.
You should also avoid rubbing your body on the treated area and avoid going into saunas, hot tubs or tanning beds for at least 4 hours to help prevent bruising, as heat can increase your blood pressure. In the first 3-4 weeks after injection, transient side effects were observed in the form of dysphagia (9%), neck muscle weakness (5%), dry mouth (2%), drowsiness (2%), muscle weakness and fatigue (5%) , headache (2%), pain in the neck muscles (8%). 14 days after the administration of botulinum toxin, other rehabilitation methods were included in the work, such as physiotherapy, therapeutic physical training, and conservative orthopedic correction methods. In 85% of patients, the antispastic effect appeared within 24 hours to 3 days after injection and reached a maximum after 10 days. In 92% of patients, the effect lasts 3-6 months. In 5% percent of patients, the antispastic effect lasted for more than a year. Casting for 14 days after injection improved results, although its use as a method of stretching during injection is inappropriate since the reduction in the stretch reflex and spasticity has not yet occurred.
Results. Due to the absence of significant side effects, botulinum therapy injections were considered safe. The effect of Botox injections is temporary, regardless of the method of use. However, after botulinum therapy, muscle spasticity decreases, which allows active implementation of other rehabilitation methods, since the patient feels less pain. Proper exercises, splinting and casting can increase the number of successful patients. Repeated injections over two years have a positive long-term effect. The injections improve the child's mobility over time. Botulinum toxin therapy for cerebral palsy should be considered in the following cases: violation of gross and fine motor skills, violation of care and hygiene constant pain disturbing dream gait disturbance
Contraindications to botulinum therapy are: Keloid scars
Neuromuscular disorders Allergy to botulinum toxin Body dysmorphic disorder
Pregnancy
Breast-feeding
Amyotrophic sclerosis
To enhance the effect of botulinum therapy and organize new skills in a child's activities,
the following methods are used:
•healing fitness ;
• conservative orthopedic therapy;
•massage;
• physiotherapeutic treatment;
• classes with a speech pathologist and psychologist
Conclusions. Botulinum toxin injections reduce muscle spasticity in children with cerebral
palsy. However, the effect of botulinum therapy improves and acquires a long-term effect in
combination with other rehabilitation methods.
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