VAIKŲ, SERGANČIŲ CEREBRINIU PARALYŽIUMI, ILGALAIKIO GYDYMO BOTULINO TOKSINU POVEIKIS ČIURNOS SĄNARIO JUDESIO AMPLITUDEI IR VAIKŲ MOBILUMUI

Introduction. Spasticity – the basic and the most common clinical syndrome of cerebral palsy. Most of the time child’s functional and movement disorders depend on this. Botulinum toxin is a drug that relaxes muscles by blocking the release of acetylcholine (ACH) in neuro muscular connection and reduces level of spasticity. The short-term effect of BTX has been proven in scientific literature and it is well known. The effect of treatment with BTX –A in a long-term remains insufficiently studied. Purpose. To evaluate the effect on changes in child’s with cerebral palsy conditions of ankle and child’s mobility over the long time (over 1 year) in the treatment with BTX-A. Method. 98 children with cerebral palsy were treated. The main indication for the treatment of BTX- A was a dynamic ankle joint contracture, resulting in functional status or movement disorders. Condition of all children were evaluated 1 month before starting the treatment with BTX; prior to each injection; within 1 – 2 months after the beginning of treatment with Dysport and after 4 months while planning further treatment with botulinum toxin. The passive ROM of child’s ankle joint was assessed with goniometer measuring the ankle of dorsiflexion while stretching the child’s knee. The functional movement of the child was assessed using the GMFM -88 scale. Results. The average age of children after first BTX-A injection was 33.29 ± 16.235 months. The majority of children (n = 45) were mobile belonging to I - II level at the GMFCS and partly mobile belonging to level III (n = 35). The number of injections of BTX –A ranged from 2 to 8 times per child. The data suggest that despite long-term treatment with BTX –A and physical therapy with the increase of child’s age the contracture of the ankle joint forms. In all cases the only criteria which are statistically significant is time. It means that passive changes in ankle joint dorsiflexion depend on its treatment time. Assessment of child’s functional movement with GMFM -88 scale showed that with each injection of BTX –A the functional movement of a child is enhanced. The highest improvement in motion has been established after the sixth injection of botulinum toxin. Conclusion. Treatment with BTX-A doesn’t have an impact on increase of passive amplitude of ankle and it doesn‘t affect the formation of contractures. Functional movements of a child improvement depend on treatment time: the best result was reached after sixth injection of BTX.