Treatment of muscle spasticity in patients with cerebral palsy using BTX‐A: a pilot study

Abstract

This study was designed to verify the safety and efficacy of botulinum toxin type A (BTX-A) used as a neuromuscular block on spastic masticatory musculature of children with cerebral palsy. Six patients who had spastic-tetraplegic cerebral-palsy, aged 5 to 20 years were selected. All patients had spasticity of the jaw muscles, bruxism, lower lip trauma, limited mouth opening, and difficulties in cleaning the oral cavity. The patients were sedated under general anesthesia, while the dentist injected the masseter and temporalis muscles bilaterally with 150 and 75 units of BTX-A each. Clinical examinations were conducted at 7, 14, 30, and 90 days after the initial appointment. We found statistically significant decreases in muscle spasticity and bruxism (p = 0.002), improved inter-incisal opening (p = 0.002), improved oral hygiene (p = 0.031), and less lower lip trauma (p = 0.060) after the neuromuscular blocking.

Utilização da toxina botulínica no tratamento do bruxismo em pacientes portadores de paralisia cerebral: revisão de literatura

“…In that study, the injection of BTX-A was well tolerated, safe, and effective for the treatment of children with spastic tetraplegic CP. That study also demonstrated a reduction in muscle spasticity, lower lip trauma, bruxism, and the ability to perform oral hygiene (19). Freud et al (1999) demonstrated that injection of BTX-A in the masseter and temporal muscles resulted in subjective reduction of pain and sensitivity among patients with neurological disorders diagnosed with temporomandibular dysfunction.…”

“…The incidence of bruxism in the general population is around 21%, but the impact on the individual with CP is still unknown (19). The causes of bruxism in CP are not yet well defined.…”

“…It generates masseter hypertrophy, headaches, temporomandibular articulation changes, flare or thickening of the periodontal ligament, and wear facets on the posterior teeth and anterior (18,19). The cause of this involvement is unknown.…”

“…It is extensively used for treating bruxism in patients with disabilities (31). The injection of BTX-A in patients with CP reduces muscle spasticity, lower lip trauma, and bruxism and improves mouth opening and the ability to perform oral hygiene (19).…”

Bruxism Control in a Child with Cerebral Palsy

“…This rhythmic grinding can cause masseter hypertrophy, headaches, temporomandibular joint destruction, and tooth wear. The incidence of bruxism in the general population has been reported to be as high as 21%, but its incidence in PC is still unknown [7]. Many factors may be involved in the etiology of this parafunctional activity such as spasticity [8]; unbalanced oral myofunctional disturbance[3, 5], backbone dysfunction with the head projected forward, which changes the contact between the teeth and predisposes hyperactivity of the main masticatory muscles (temporal and masseteric) [9], lack of control of the mandibular posture which can worsen in periods of emotional stress [10]; sleep disorders [11]; use of neuroleptics [5] and malocclusion [12].…”