The effectiveness of combined use of botulinum toxin therapy and functional electrical stimulation in ambulatory patients with spastic forms of cerebral palsy

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Abstract


Introduction. Cerebral palsy (CP) is a severe neurological disease, the clinical picture of which is dominated by motor disorders. In spastic forms of CP, in addition to increasing muscle tone and spasticity, a significant number of muscles are functionally weakened with signs of paresis. To correct these disorders, close attention has recently been paid to two therapeutic approaches — botulinum therapy and functional electrical stimulation (FES).

The purpose of our investigation was to study the efficiency of combined use of botulinum therapy and FES in children with CP levels I-III according to the Gross Motor Function Classification System (GMFCS).

Material and methods. The study included 40 CP patients. 20 children (10 with spastic diplegia and 10 with hemiplegic form) treated with Abobotulinumtoxin A and FES formed the main group. The control group included 20 children (11 with spastic diplegia and 9 with hemiplegic form) who received botulinum therapy without subsequent FES.

Results. When evaluated 2 weeks later (after the end of the course of treatment) an increased muscle tone and spasticity of the gastrocnemius muscles significantly decreased in both the main and control groups. Following the complex treatment of Abobotulinum toxin A in combination with FES the range of motion in the ankle joint in the main group was significantly greater than in the control group. These differences in the increase in the range of motion were observed both during passive dorsiflexion of the foot (p=0.044) and when patients performed maximum voluntary muscle contraction (p=0.036).

Conclusion. In the main group of patients, the combined use of botulinum therapy and FES proved to be highly effective in correcting spasticity and increasing the range of motion in the ankle joint. The course of FES performed in patients of the main group has an additional therapeutic effect, which in complex treatment gives a significantly greater positive result.


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About the authors

A. L. Kurenkov

National Medical Research Center for Children’s Health, of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: alkurenkov@gmail.com
ORCID iD: 0000-0002-7269-9100

Russian Federation, Moscow

MD, PhD

D. A. Fisenko

Lomonosov Moscow State University

Email: alkurenkov@gmail.com
ORCID iD: 0000-0002-7893-1863

Russian Federation, Moscow

MD, Ph.D., DSc., Prof.

L. M. Kuzenkova

National Medical Research Center for Children’s Health, of the Ministry of Health of the Russian Federation; N.F. Filatov Clinical Institute of Children's Health, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University),

Email: alkurenkov@gmail.com
ORCID iD: 0000-0002-9562-3774

Russian Federation, Moscow

MD, Ph.D., DSc., Prof.

V. V. Chernikov

National Medical Research Center for Children’s Health, of the Ministry of Health of the Russian Federation

Email: alkurenkov@gmail.com
ORCID iD: 0000-0002-8750-9285

Russian Federation, Moscow

pediatrician

F. G. Litvak

LLC «ITC Integral»

Email: alkurenkov@gmail.com
Moscow

U. S. Ashrafova

National Medical Research Center for Children’s Health, of the Ministry of Health of the Russian Federation

Email: alkurenkov@gmail.com
ORCID iD: 0000-0003-1721-5609

Russian Federation, Moscow

O. S. Kuprianova

National Medical Research Center for Children’s Health, of the Ministry of Health of the Russian Federation

Email: alkurenkov@gmail.com
ORCID iD: 0000-0002-9816-6919

Russian Federation, Moscow

B. I. Bursagova

National Medical Research Center for Children’s Health, of the Ministry of Health of the Russian Federation

Email: alkurenkov@gmail.com
ORCID iD: 0000-0001-8506-2064

Russian Federation, Moscow

MD, Ph.D.

References

  1. Graham H.K., Rosenbaum P., Paneth N., Dan B., Lin J.P., Damiano D.L., et al. Cerebral palsy. Nat. Rev. Dis. Primers. 2016; (2): 15082. DOI: http://doi.org/10.1038/nrdp.2015.82
  2. Spittle A.J., Morgan C. Early intervention for children with cerebral palsy. In: Panteliadis C.P., ed. Cerebral Palsy: A Multidisciplinary Approach. Cham: Springer; 2018: 193-200.
  3. Пак Л.А. Мультидисциплинарное сопровождение детей с детским церебральным параличом: Дисс. ... д-ра мед. наук. М.; 2019.
  4. Staudt M. Reorganization after pre- and perinatal brain lesions. J. Anat. 2010; 217(4): 469-74. DOI: http://doi.org/10.1111/j.1469-7580.2010.01262.x
  5. Hagel C. Neuropathology of cerebral palsy. In: Panteliadis C.P., ed. Cerebral Palsy: A Multidisciplinary Approach. Cham: Springer; 2018: 35-48.
  6. Strobl W., Theologis T., Brunner R., Kocer S., Viehweger E., Pascual-Pascual I., et al. Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins (Basel). 2015; 7(5): 1629-48. DOI: http://doi.org/10.3390/toxins7051629
  7. Куренков А.Л., Клочкова О.А., Змановская В.А., Фальковский И.В., Кенис В.М., Владыкина Л.Н. и др. Первый Российский консенсус по применению многоуровневых инъекций Abobotulinumtoxin A при лечении спастических форм детского церебрального паралича. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016; 11(116): 121-30. DOI: http://doi.org/10.17116/jnevro2016116111121-130
  8. Multani I., Manji J., Hastings-Ison T., Khot A., Graham K. Botulinum toxin in the management of children with cerebral palsy. Paediatr. Drugs. 2019; 21(4): 261-81. DOI: http://doi.org/10.1007/s40272-019-00344-8
  9. Pool D., Valentine J., Blackmore A.M., Colegate J., Bear N., Stannage K., et al. Daily functional electrical stimulation during everyday walking activities improves performance and satisfaction in children with unilateral spastic cerebral palsy: a randomized controlled trial. Arch. Physiother. 2015; 5: 5. DOI: http://doi.org/10.1186/s40945-015-0005-x
  10. Доценко В.И., Титаренко Н.Ю. Объективные инструментальные критерии оценки эффективности функциональной программируемой электромиостимуляции в ходьбе у больных с ортопедо-неврологической патологией. Поликлиника. 2019; (6): 49-52.
  11. Damiano D.L., Prosser L.A., Curatalo L.A., Alter K.E. Muscle plasticity and ankle control after repetitive use of a functional electrical stimulation device for foot drop in cerebral palsy. Neurorehabil. Neural Repair. 2013; 27(3): 200-7. DOI: http://doi.org/10.1177/1545968312461716
  12. Salazar A.P., Pagnussat A.S., Pereira G.A., Scopel G., Lukrafka J.L. Neuromuscular electrical stimulation to improve gross motor function in children with cerebral palsy: a meta-analysis. Braz. J. Phys. Ther. 2019; 23(5): 378-86. DOI: http://doi.org/10.1016/j.bjpt.2019.01.006
  13. Heinen F., Desloovere K., Schroeder A.S., Berweck S., Borggraefe I., van Campenhout A., et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur. J. Paediatr. Neurol. 2010; 14(1): 45-66. DOI: http://doi.org/10.1016/j.ejpn.2009.09.005
  14. Баранов А.А., Намазова-Баранова Л.С., Куренков А.Л., Клочкова О.А., Каримова Х.М., Мамедъяров А.М. и др. Комплексная оценка двигательных функций у пациентов с детским церебральным параличом. М.: Педиатръ; 2014.
  15. Novak I., Morgan C., Fahey M., Finch-Edmondson M., Galea C., Hines A., et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr. Neurol. Neurosci. Rep. 2020; 20(2): 3. DOI: http://doi.org/10.1007/s11910-020-1022-z
  16. Leonard J., Graham H.K. Treatment of motor disorders in cerebral palsy with botulinum neurotoxin. In: Jankovic J., et al. Botulinum Toxin: Therapeutic Clinical Practice and Science. Philadelphia: Saunders Elsevier; 2009: 172-91.
  17. Sanger T.D., Chen D., Delgado M.R., Gaebler-Spira D., Hallett M., Mink J.W. Definition and classification of negative motor signs in childhood. Pediatrics. 2006; 118(5): 2159-67. DOI: http://doi.org/10.1542/peds.2005-3016
  18. Кожевникова В.Т. Современные технологии физической реабилитации больных с последствиями перинатального поражения нервной системы и детским церебральным параличом. М.: Маджента; 2013.
  19. Пинчук Д.Ю. Биологически обратная связь по электромиограмме в неврологии и ортопедии: справочное руководство. СПб.; 2002.
  20. Prosser L.A., Curatalo L.A., Alter K.E., Damiano D.L. Acceptability and potential effectiveness of a foot drop stimulator in children and adolescents with cerebral palsy. Dev. Med. Child Neurol. 2012; 54(11): 1044-9. DOI: http://doi.org/10.1111/j.1469-8749.2012.04401.x
  21. Rossini P.M., Burke D., Chen R., Cohen L.G., Daskalakis Z., Di Iorio R., et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin. Neurophysiol. 2015; 126(6): 1071-107. DOI: http://doi.org/10.1016/j.clinph.2015.02.001
  22. Змановская В.А., Левитина Е.В., Попков Д.А., Буторина М.Н., Павлова О.Л. Длительное применение препарата ботулинического токсина типа А: Диспорт в комплексной реабилитации детей со спастическими формами церебрального паралича. Журнал неврологии и психиатрии им. С.С. Корсакова. 2014; 114(7): 33-6.
  23. Delgado M.R., Tilton A., Russman B., Benavides O., Bonikowski M., Carranza J., et al. AbobotulinumtoxinA for equinus foot deformity in cerebral palsy: a randomized controlled trial. Pediatrics. 2016; 137(2): e20152830. DOI: http://doi.org/10.1542/peds.2015-2830
  24. Franzén M., Hägglund G., Alriksson-Schmidt A. Treatment with Botulinum toxin A in a total population of children with cerebral palsy — a retrospective cohort registry study. BMC Musculoskelet. Disord. 2017; 18(1): 520. DOI: http://doi.org/10.1186/s12891-017-1880-y
  25. Galen S., Wiggins L., McWilliam R., Granat M. A combination of botulinum toxin A therapy and functional electrical stimulation in children with cerebral palsy — a pilot study. Technol. Health Care. 2012; 20(1): 1-9. DOI: http://doi.org/10.3233/THC-2011-0648
  26. Pool D., Blackmore A.M., Bear N., Valentine J. Effects of short-term daily community walk aide use on children with unilateral spastic cerebral palsy. Pediatr. Phys. Ther. 2014; 26(3): 308-17. DOI: http://doi.org/10.1097/PEP.0000000000000057
  27. Comeaux P., Patterson N., Rubin M., Meiner R. Effect of neuromuscular electrical stimulation during gait in children with cerebral palsy. Pediatr. Phys. Ther. 1997; 9: 103-9.
  28. Kerr C., McDowell B., McDonough S. Electrical stimulation in cerebral palsy: a review of effects on strength and motor function. Dev. Med. Child Neurol. 2004; 46(3): 205-13. DOI: http://doi.org/10.1017/s0012162204000349
  29. Postans N.J., Granat M.H. Effect of functional electrical stimulation applied during walking, on gait in spastic cerebral palsy. Dev. Med. Child Neurol. 2005; 47(1): 46-52. DOI: http://doi.org/10.1017/s0012162205000083
  30. Van der Linden M.L., Hazlewood M.E., Hillman S.J., Robb J.E. Functional electrical stimulation to the dorsiflexors and quadriceps in children with cerebral palsy. Pediatr. Phys. Ther. 2008; 20(1): 23-9. DOI: http://doi.org/10.1097/PEP.0b013e31815f39c9
  31. Merrill D.R. Review of electrical stimulation in cerebral palsy and recommendations for future directions. Dev. Med. Child Neurol. 2009; 51(Suppl. 4): 154-65. DOI: http://doi.org/10.1111/j.1469-8749.2009.03420.x
  32. Brien M., Sveistrup H. An intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy. Pediatr. Phys. Ther. 2011; 23(3): 258-66. DOI: http://doi.org/10.1097/PEP.0b013e318227ca0f
  33. Moll I., Vles J.S.H., Soudant D.L.H.M., Witlox A.M.A., Staal H.M., Speth L.A.W.M., et al. Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review. Dev. Med. Child Neurol. 2017; 59(12): 1230-6. DOI: http://doi.org/10.1111/dmcn.13501
  34. Hazlewood M.E., Brown J.K., Rowe P.J., Salter P.M. The use of therapeutic electrical stimulation in the treatment of hemiplegic cerebral palsy. Dev. Med. Child Neurol. 1994; 36(8): 661-73. DOI: http://doi.org/10.1111/j.1469-8749.1994.tb11909.x

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Copyright (c) 2020 Kurenkov A.L., Fisenko D.A., Kuzenkova L.M., Chernikov V.V., Litvak F.G., Ashrafova U.S., Kuprianova O.S., Bursagova B.I.

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