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Clinical Experience of the Repeated Multilevel Injections of the Botulinum Toxin Type A (Abobotulinum toxin A) in the Spastic Forms of Cerebral Palsy Objective: Our aim was to analyze the dosages of Abobotulinum toxin A used for each muscle in the clinically effective and safe repeated multilevel injections in CP children, and the intervals between injections. Methods: Retrospective analysis of 229 injection sessions into 359 muscles of the upper and 361 muscles of the lower extremities in 133 children (2-18 years) with spastic CP. Analysis included only patients who were injected for the first time and demonstrated decrease of spasticity in injected muscles according to modified Ashworth and/or Tardieu scales without significant side effects 2-4 weeks after injections.

also at 2 weeks from injury compared with healthy control children.Methods Whole blood was sampled from children with mild TBI within 24 hours of injury and at two weeks from injury and compared to healthy paediatric controls at baseline. RNA was isolated and cDNA was synthesized. Gene Expression of NLRP3 and IL1 b via rtPCR was recorded in 22 patients and 5 controls at baseline and 15 patients at 2 weeks. The Post Concussive Symptom Inventory was administered at 2 weeks. A change from pre-injury baseline was recorded.Results Inflammasome was upregulated via NLRP3 expression in children with TBI compared to controls across groups however this did not correlate with symptoms at 2 weeks. Higher IL-1b transcription levels at presentation were positively correlated by Pearson correlation (p = 0.029) with higher symptom scores at 2 weeks. Conclusion Inflammation is altered in TBI compared to controls The NLRP3 component of inflammasome while elevated does not correlate with symptom burden. IL=1 b gene transcription does. IL-1 b holds promise in predicting symptom burden following mTBI. Selective inhibition of systemic inflammation targeting the inflammasome may have a future immunomodulatory role as a target in treating mTBI.

Spasticity treatment is one of the key aspects of the contemporary cerebral palsy (CP) rehabilitation that influences on the effectiveness of other methods. The paper presents the first Russian document that unites the recommendations for the BTA treatment of CP and could be used as the guideline for the multilevel injections. The Russian consensus on the multilevel botulinum toxin A (BTA) treatment of spastic CP is based on the international data and the results of national studies. The authors describe typical CP spasticity patterns in the upper and lower extremities, give recommended intervals for the BTA (Abobotulinum toxin A) dosages for the whole injection procedure and for the separate muscles. The method of dosage calculation for functional segments is also described. Attention is paid to the frequency, optimal intervals between the repeated injections and the whole duration of BTA treatment. The authors discuss effectiveness and safety of BTA, factors that potentially influence the results of the injections, including ultrasound and electromyography control, and indications for the continuation and termination of treatment.