Botulinum toxin treatment of cocontractions after birth-related brachial plexus lesions

Jd, Rollnik; Hierner, R.; Schubert, Mark M.; Shen, Zhe; Johannes, S Vrouwenvelder; Tröger, M.; Wohlfarth, Kai; Berger, A; Dengler, Reinhard

doi:10.1212/wnl.55.1.112

Cited by 75 publications

(78 citation statements)

References 5 publications

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“…Rollnik et al treated six girls with OBP (age: 2 to 4 years) administering BTA to the triceps muscle (Dysport ® , Ipsen), with an average dose of 40U 4 . All patients showed an improvement of elbow flexion strength and range of motion, and no adverse side effects were re p o rted.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of OBP patients includes one or more of the followings: physiotherapy, re c o n s t ru c t i v e plexus surg e ry and correction of secondary deformities. The use of botulinum toxin type A (BTA ) was recently introduced to treat biceps -triceps muscle cocontractions and improve the functional performance of these children 4,5 . This is a re p o rt of our pre l i m i n a ry experience with this new approach.…”

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confidence: 99%

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Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy

Heise

Gonçalves

Barbosa

et al. 2005

Arq. Neuro-Psiquiatr.

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-Botulinum toxin type A was recently introduced for treatment of biceps -triceps muscle cocontraction, which compromises elbow function in children with obstetrical brachial plexopathy. This is our preliminary experience with this new approach. Eight children were treated with 2 -3 U/kg of botulinum toxin injected in the triceps (4 patients) and biceps (4 patients) muscle, divided in 2 or 3 sites. All patients submitted to triceps injections showed a long-lasting improvement of active elbow flexion and none re q u i red new injections, after a follow-up of 3 to 18 months. Three of the patients submitted to biceps injections showed some improvement of elbow extension, but none developed anti-gravitational stre n g t h for elbow extension and the effect lasted only three to five months. One patient showed no response to triceps injections. Our data suggest that botulinum toxin can be useful in some children that have persistent disability secondary to obstetrical brachial plexopathy.KEY WORDS: botulinum toxin type A, obstetric paralysis, drug therapy.Toxina botulínica para tratamento das co-contrações relacionadas à plexopatia braquial obstétrica RESUMO -A toxina botulínica do tipo A foi introduzida recentemente para o tratamento das co-contrações e n t re os músculos biceps e triceps, que comprometem a função do cotovelo nas crianças com plexopatia braquial obstétrica. Apresentamos nossa experiência preliminar com esta abordagem. Oito crianças foram tratadas com 2 -3 U/kg de toxina botulínica injetada nos músculos triceps (4 pacientes) e biceps (4 pacientes), divididas em 2 ou 3 sítios. Todos os pacientes submetidos a injeções no triceps apresentaram melhora persistente da flexão do cotovelo e nenhum precisou de novas aplicações após seguimento de 3 a 18 meses. Três pacientes submetidos a aplicações no biceps apresentaram melhora na extensão do cotovelo, mas nenhum adquiriu força antigravitacional e o efeito durou apenas 3 a 5 meses. Um paciente não re s p o n d e u às injeções. Nossos dados sugerem que a toxina botulínica pode ser útil no tratamento de algumas crianças com seqüelas de plexopatia braquial obstétrica. PALAVRAS-CHAVE: toxina botulínica tipo A, paralisia obstétrica, terapia por drogas.The incidence of obstetrical brachial plexopathy (OBP) in developed countries is around 0.15% and has not been reduced despite progress in obst e t r i c s 1 . Upper brachial plexus lesions (C5-C6) are almost always present in OBP, either in isolated form, or in association with middle (C7) and lower (C8-T1) brachial plexus lesions 2 . Most of the patients with OBP will fully recover after a few m o n t h s 3 , but 5% to 25% will remain handicapped 1,3 . Treatment of OBP patients includes one or more of the followings: physiotherapy, re c o n s t ru c t i v e plexus surg e ry and correction of secondary deformities. The use of botulinum toxin type A (BTA ) was recently introduced to treat biceps -triceps muscle cocontractions and improve the functional performance of these children 4,5 . This is a re p o rt of...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy

Heise

Gonçalves

Barbosa

et al. 2005

Arq. Neuro-Psiquiatr.

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“…Wrist splinting can help to enhance hand function in cases of wrist drop 48 , as long as it does not prevent limb use during daytime. Aberrant reinnervation can result in biceps-triceps cocontraction 19 , which can be treated with botulinum toxin 52 . This can also be used to prevent muscle contracture of the shoulder internal rotators 40 .…”

Section: Rehabilitationmentioning

confidence: 99%

Neonatal brachial plexus palsy: a permanent challenge

Heise

Martins

Siqueira

2015

Arq. Neuro-Psiquiatr.

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Neonatal brachial plexus palsy (NBPP) has an incidence of 1.5 cases per 1000 live births and it has not declined despite recent advances in obstetrics. Most patients will recover spontaneously, but some will remain severely handicapped. Rehabilitation is important in most cases and brachial plexus surgery can improve the functional outcome of selected patients. This review highlights the current management of infants with NBPP, including conservative and operative approaches.

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“…Se ha comprobado que el efecto de la toxina botulínica tipo A aplicada en el tríceps, tiene resultados positivos al debilitar el múscu-lo transitoriamente, permitiendo su elongación, mientras se entrena (reeduca) y fortalece su antagonista (bíceps). 18,19 Esta es otra herramienta de la que disponemos para combinar junto con las cirugías nerviosas y de transferencia tendinosa.…”

Section: Tratamiento Quirúrgico Y Sus Posibles Combinacionesunclassified

Conceptos actuales en la parálisis braquial perinatal. Parte 2: etapa tardía. Deformidades en hombro

Dogliotti¹

2011

Arch Argent Pediat

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RESUMENLa parálisis braquial tiene una incidencia relativamente alta, y sus secuelas son habituales. La rehabilitación, la microcirugía y las cirugías paliativas sobre partes blandas y huesos son utilizadas en forma conjunta. La postura más común del hombro es rotación interna y aducción, debido a la parálisis de los músculos antagonistas. El desequilibrio mantenido de fuerzas musculares sobre el sistema osteoarticular, determinará una deformidad progresiva glenohumeral que se estudia con resonancia magnética nuclear. La transferencia del dorsal ancho y redondo mayor al troquiter tiene buenos resultados, pero debe adelantarse y combinarse con liberación antero-inferior, si existe limitación de la movilidad pasiva. Palabras clave: secuela de parálisis braquial obsté-trica, parálisis obstétrica en etapa secuelar, secuela en parálisis braquial, displasia glenohumeral, transferencia tendinosa en hombro. ABSTRACTThe incidence of obstetric brachial palsy is high and their sequelaes are frequent. Physiotherapy, microsurgical nerve reconstruction and secondary corrections are used together to improve the shoulder function. The most common posture is shoulder in internal rotation and adduction, because of the antagonist weakness. The muscle forces imbalance over the osteoarticular system, will result in a progressive glenohumeral joint deformity which can be recognized with a magnetic resonance image. Tendon transfers of the internal rotators towards the external abductor/rotator muscles, has good results, but has to be combined with antero-inferior soft-tissue releases, if passive range of motion is limited. Key words: brachial plexus birth palsy, obstetrical palsy sequelae, shoulder sequelae in obstetric brachial plexus palsy, glenohumeral joint deformity, tendon transfer arround the shoulder.

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Botulinum toxin treatment of cocontractions after birth-related brachial plexus lesions

Cited by 75 publications

References 5 publications

Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy

Botulinum toxin for treatment of cocontractions related to obstetrical brachial plexopathy

Neonatal brachial plexus palsy: a permanent challenge

Conceptos actuales en la parálisis braquial perinatal. Parte 2: etapa tardía. Deformidades en hombro

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