Pd4: Longitudinal Examination of Outcomes Associated With Botulinum Toxin Use in Children With Cerebral Palsy

Balkrishnan, Rajesh; Camacho, Fabian; Bp, Smith; Koman, AL

doi:10.1016/s1098-3015(10)63815-6

Cited by 5 publications

(8 citation statements)

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“…Injections may be repeated, if need be, as assessed by motor recovery outcome measures. There is growing evidence from recent clinical studies that low-dose [45] and repeat injections [16,[46][47][48][49] are very effective compared to high-dose, single session procedures.…”

Section: Keep the Paralyzing Effect Minimized -Prolong The Relearningmentioning

confidence: 99%

“…The benefits were transient and spasticity returned later. More recent studies that have used BoTx into multiple muscles and in repeat sessions had reported that BoTx brings improvement in function besides spasticity relief [2,3,[15][16][17][18][19][20]. The principal objective of the present paper is that future BoTx clinical studies will take note of the relearning properties of this drug and make full utilization of this therapeutic effect.…”

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confidence: 95%

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Botulinum Toxin as a Neuro-Relearning Drug Tool in Motor Paralytic Disorders

Krishnan

2009

CDTH

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The clinical use of Botulinum toxin (BoTx) in motor paralytic disorders until now is limited to spasticity relief in isolated spastic muscle/s. This paper advocates that BoTx should be used as a neuro-relearning tool that can significantly improve recovery in motor paralytic disorders. BoTx generates redundant numbers of synapses at motor endplates and at spinal motoneuron-interneurons. It facilitates muscle activity-dependent synapse competition at these two sites. Redundancy and competition-based selection of synaptic connections are naturally occurring learning-related plasticity events during infant motor learning-now familiarly known as competitive-learning. Thus when injected in small doses to multiple muscles of a paralyzed limb, BoTx can recreate and replay those competitive-learning processes in the learningresistant paralyzed brain centers. Computational modeling, humanoid robot, and animal studies reveal that motor re) learning can be significantly faster if competitive-learning mechanisms are employed in the paralyzed system. A treatment protocol is presented that aims to keep the paralyzing effects of BoTx minimized while prolonging relearning duration. Recent clinical studies strongly attest that small-dose; multi-muscle, repeat regimens improve function. The principal objective of the present paper is that future multi-muscle clinical studies will take note of the relearning properties of BoTx and make full utilization of this therapeutic effect.Key Words: Botulinum toxin, cerebral palsy, motor paralysis, spinal cord injury, stroke, traumatic brain injury (TBI). THE TWO FACES OF BOTXBotulinum toxin (BoTx) is being extensively used in the treatment of a variety of disorders e.g. spasticity relief in skeletal muscles, in glandular disorders e.g. hyperhidrosis and sialorrhoea, and in urological disorders e.g. bladdersphincter dyssynergia, besides many others. In motor paralytic disorders, the clinical use of BoTx until now is limited to spasticity relief in isolated, spastic muscle/s. This paper advocates that BoTx should be used as a neuro-relearning tool that can significantly improve recovery in motor paralytic disorders. Botulinum toxin (BoTx) has two distinct, but closely inter-related function facets. First is its acetylcholine release-blocking property that relieves spasticity by paralyzing that overactive muscle. This beneficial effect is temporary however, for as the effects of the toxin vanes off the spasticity returns [1-3]. The second is its extensive plasticityinducing property. BoTx generates profound transient plasticity at motor endplates, spinal motoneuron soma-dendrites, spinal interneurons, and cerebral sensory-motor cortex. This includes motoneuron soma size plasticity, dendro-dendritic coupling, new synapses formation, synapse competition, modifications of excitation-inhibition, motoneuron firing frequency, reflex response, long-latency polysynaptic pathways, cortical maps reorganizations etc among others [4]. Interesting to note, this widespread structural and functional BoTx pla...

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Section: Keep the Paralyzing Effect Minimized -Prolong The Relearningmentioning

confidence: 99%

mentioning

confidence: 95%

Botulinum Toxin as a Neuro-Relearning Drug Tool in Motor Paralytic Disorders

Krishnan

2009

CDTH

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“…The most recent assessment at Wake Forest University School of Medicine included 172 children who received injections of BoNT-A for the treatment of spastic-type cerebral palsy 15 . A mixed modeling procedure was used to identify changes both in physical functioning outcomes (Functional Independence Measure for Children 16 ) as well as in quality of life of the parent caregiver (Stein and Riessman Impact on the Family Scale 17 ).…”

Section: Dosing and Injection Techniquementioning

confidence: 99%

Botulinum Neurotoxin as a Therapeutic Modality in Orthopaedic Surgery: More Than Twenty Years of Experience

Seyler

Smith

Marker

et al. 2008

Journal of Bone and Joint Surgery

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“…The most frequently used general scale was the SF-36, 4,41,42,65 but several studies used the EuroQoL scale, 4,42,48 and single studies used the Nottingham Health Profile, 52 General Health Questionnaire, 49 Glasgow Benefit Inventory, 47 and the Stein and Reissman Family Impact Scale. 53 One of these studies examined the effects of BTX-A on parent-rated severity of their children's condition (scale range, 1-7 points) and quality of life of the parent caregiver using the Stein and Reissman Family Impact Scale. 53 Both the quality of life and severity measures showed significant improvement following BTX-A treatment that continued to accrue with successive treatment injections over the 2-year study period.…”

Section: Quality Of Life/patient-rated Global Outcomesmentioning

confidence: 99%

“…53 One of these studies examined the effects of BTX-A on parent-rated severity of their children's condition (scale range, 1-7 points) and quality of life of the parent caregiver using the Stein and Reissman Family Impact Scale. 53 Both the quality of life and severity measures showed significant improvement following BTX-A treatment that continued to accrue with successive treatment injections over the 2-year study period. Of the 6 studies that employed disease-specific quality-of-life questionnaires, all found significant improvement with BTX-A 46,47,57-59,73 (one study did not specify the Quality-of-Life scale used 26 ).…”

Section: Quality Of Life/patient-rated Global Outcomesmentioning

confidence: 99%

Evidence-Based Review of Patient-Reported Outcomes With Botulinum Toxin Type A

Jankovic

Esquenazi²,

Freitag³

et al. 2004

Clinical Neuropharmacology

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This review systematically examines the effects of botulinum toxin type A (BTX-A) on patient-reported outcomes across disorders using evidence-based criteria. The evidence provided by these studies ranged from randomized, controlled trials to case series. The effects of BTX-A on quality of life or global treatment outcomes were assessed in 48 studies across 16 different conditions. All but 7 of these reported benefits of BTX-A over baseline or the comparator condition (placebo or other treatment). The effects of BTX-A on impairment, activities, or participation were assessed in 46 studies across 17 different conditions. All but 4 reported benefits of BTX-A over baseline or the comparison group. The effects of BTX-A on satisfaction or preference were assessed in 14 studies across 11 different conditions, all of which reported high rates of satisfaction with BTX-A or preference over the comparator. These studies provide evidence that BTX-A exerts meaningful benefits on the quality of life of patients treated with this biologic agent.

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Pd4: Longitudinal Examination of Outcomes Associated With Botulinum Toxin Use in Children With Cerebral Palsy

Cited by 5 publications

References 0 publications

Botulinum Toxin as a Neuro-Relearning Drug Tool in Motor Paralytic Disorders

Botulinum Toxin as a Neuro-Relearning Drug Tool in Motor Paralytic Disorders

Botulinum Neurotoxin as a Therapeutic Modality in Orthopaedic Surgery: More Than Twenty Years of Experience

Evidence-Based Review of Patient-Reported Outcomes With Botulinum Toxin Type A

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