Cerebral palsy

Abstract

Cerebral palsy, a range of non-progressive syndromes of posture and motor impairment, is a common cause of disability in childhood. The disorder results from various insults to different areas within the developing nervous system, which partly explains the variability of clinical findings. Management options include physiotherapy, occupational and speech therapy, orthotics, device-assisted modalities, pharmacological intervention, and orthopaedic and neurosurgical procedures. Since 1980, modification of spasticity by means of orally administered drugs, intramuscular chemodenervation agents (alcohol, phenol, botulinum toxin A), intrathecally administered drugs (baclofen), and surgery (neurectomy, rhizotomy) has become more frequent. Family-directed use of holistic approaches for their children with cerebral palsy includes the widespread adoption of complementary and alternative therapies; however, the prevalence of their use and the cost of these options are unknown. Traditional medical techniques (physiotherapy, bracing, and orthopaedic musculoskeletal surgery) remain the mainstay of treatment strategies at this time. This seminar addresses only the musculoskeletal issues associated with cerebral palsy and only indirectly discusses the cognitive, medical, and social issues associated with this diagnosis.

The effects of botulinum toxin injection frequency on calf muscle growth in young children with spastic cerebral palsy: A 12-month prospective study

“…The standard of care for spasticity management involves a combination of modalities, including physiotherapy, orthotics, oral pharmacological agents and neuromuscular blocking agents such as BoNT-A [4,[52][53][54]. The problem of muscle weakness is increasingly being acknowledged as a primary source of functional impairment in spastic CP [55].…”

A Dynamic Systems: constraints approach to rehabilitation

“…The cost of care for individuals with CP is estimated at about $8.2b for 2002 in the USA alone 34 . The number of children who suffer from cerebral palsy has shown rather large increases 35 as the percentage of very low birth weight (VLBW) babies (weighing 1500gm or less), a highly significant risk factor for the development of CP 36 , has increased by 32% between 1990 and 2004 37 .…”

Dose‐ and volume dependent‐response to intramuscular injection of botulinum neurotoxin‐A optimizes muscle force decrement in mice

“…1 Chemodenervation with BoNTA has important clinical uses in the management of neuromuscular disorders including achalasia, hyperhydrosis, and spasticity and an emerging role as tendon bioprotection. [2][3][4][5][6] Although many clinicians administer BoNTA injections, little consensus exists regarding the appropriate injection dose and volume. 2,7,8 Clinical preparations for BoNTA intramuscular injection are most commonly in concentrations of 50 and 100 U/ml with an injection volume of 2-4 ml, but may be as concentrated as 500 U/ml and injected in volumes of up to 8 ml.…”

“…[2][3][4][5][6] Although many clinicians administer BoNTA injections, little consensus exists regarding the appropriate injection dose and volume. 2,7,8 Clinical preparations for BoNTA intramuscular injection are most commonly in concentrations of 50 and 100 U/ml with an injection volume of 2-4 ml, but may be as concentrated as 500 U/ml and injected in volumes of up to 8 ml. 2,7,9 Furthermore, the dose administered to reach clinical goals in muscle tone is highly variable.…”

“…2,7,8 Clinical preparations for BoNTA intramuscular injection are most commonly in concentrations of 50 and 100 U/ml with an injection volume of 2-4 ml, but may be as concentrated as 500 U/ml and injected in volumes of up to 8 ml. 2,7,9 Furthermore, the dose administered to reach clinical goals in muscle tone is highly variable. [7][8][9] Endocytotic uptake of BoNTA by the distal neuron results in a conformational change in the light chain with subsequent proteolytic cleavage of the vesicle docking protein, SNAP-25.…”