Journal de la Faculté de Médecine
Volume 3, Numéro 6, Pages 435-446
Abstract Ankle spasticity in the cerebral palsy walking child: comparative study botulinum toxin A versus rehabilitation. The spastic form of cerebral palsy (PC) is very common, accounting for more than 80% of PC cases. Spasticity leads to muscle contractures and bone deformities accountable for activity and participation limitations in growing children. The treatment of ankle spasticity relies mainly on intramuscular injections of botulinum toxin A and rehabilitation. Aim - The purpose of this paper was to access the efficacy and the limits of bot toxinA in comparing the therapeutic evolution of the ankle spasticity during three controls (at one month, three months and six months) in the groups treated respectively by botulinum toxin A alone, rehabilitation alone and the combination of these two therapies, and to compare the outcomes of therapeutic evolution in the three groups on gait. Patients and methods - A comparative randomized descriptive study in three therapeutic groups (botulinum toxin group «A» associated with rehabilitation (G1), botulinum toxin group «A» (TBA) alone (G2), rehabilitation group alone (G3) during the controls and involving 122 lower limbs of 72 children (24 children per group) with spastic CP, classified GMFCS (I to III) and aged from 2 to 16 years. The clinical evaluation was done by the Modified Tardieu scale (MTS) for passive amplitudes and spasticity, PRS (Physicians Rating Scale) for walking. This study was carried out in the physical and rehabilitation medicine PRM department of Oran’s hospital and university center during the period of January 2016 to June 2017. The Tardieu Scale measures spasticity using 2 parameters: the spasticity angle X is the difference between the angles of arrest at slow speed and of catch-and-release or clonus at fast speed, whereas the spasticity grade Y is an ordinal variable that grades the intensity and thus measures the gain of the muscle reaction to fast stretch. Results - In the intervention groups, the combination of TBA and rehabilitation gave a statistically significant improvement in the ankle of the mean angle of passive dorsiflexion of the flexed knee ankle (p = 0.04) and tense knee (p = 0.003) in the first month. This improvement continues in the third and sixth months. The decrease in the mean angle of onset of flexed knee and tense knee spasticity was statistically significant in the first month (p = 0.03, p≤10-3) and in the third month. Mean soleus and gastrocnemius tone decreased statistically significantly in all three controls. In G2, the improvement of the average angle of the dorsal flexion, flexed knee and stretched knee, occurs in the third month (p = 0.05, p = 0.003). The improvement in the average angle of onset of spasticity and tone was statistically significant in the first and third months. In the G3 improvement of the mean of all these parameters was statistically insignificant. Conclusion - Rehabilitation associated with abobotulinumtoxin «A» injections gives better results on joint amplitudes, muscle tone and walking quality in children walking spastic CP. These results are maintained until the sixth month.
spasticity, equinus, cerebral palsy, walking child, abobotulinumtoxin A, rehabilitation
Fatima Zohra Bouterfa