Vol 1, No 2 (2020)

From the editor
Pak L.A.

...So be famous for many generations, Stubborn hearts are hot, do not know fear and doubt, beautiful and bright doctors!E. Asadov

L.O. Badalyan Neurological Journal. 2020;1(2):78
Original studies
The effectiveness of combined use of botulinum toxin therapy and functional electrical stimulation in ambulatory patients with spastic forms of cerebral palsy
Kurenkov A.L., Fisenko D.A., Kuzenkova L.M., Chernikov V.V., Litvak F.G., Ashrafova U.S., Kuprianova O.S., Bursagova B.I.

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.

L.O. Badalyan Neurological Journal. 2020;1(2):80-90
Correction of neuroorthopedic disorders in children with cerebral palsy
Chelpachenko O.B., Zherdev K.V., Fisenko A.P., Dyakonova E.Y.

Introduction. In the National Medical Research Center for Children’s Health of the Ministry of health of Russia there was introduced a system of comprehensive treatment of cerebral palsy children using a multidisciplinary approach with the patient’s habilitation potential. According to the European consensus of treatment of cerebral palsy, there are main groups of therapeutic effects: oral anti-spastic pharmacotherapy, orthopedic surgery, botulinum therapy, intrathecal administration of baclofen, orthosis, functional therapy. Orthopaedic surgery is necessary for the treatment of secondary joint contractures and skeletal deformities in cerebral palsy.

The aim of the study was to optimize the comprehensive abilitation of children with cerebral palsy, taking into account the prognosis of the patient’s motor development.

Patients and Methods. An analysis of the effectiveness of surgical treatment of 718 patients with neuroorthopedic pathology against the background of spastic forms of cerebral palsy was made. Among the operated patients, 290 patients had spastic instability of the hip joints, 147 cases suffered from contractures or axial deformities of the lower extremities at the level of the knee joints, 245 – neurogenic deformities of the feet, and 36 – with deformities of the thoracic spine. Patients with neuroorthopedic pathology who were operated at the second stage (n = 476) made up the 2nd group (a prospective study). They were treated in the neuro-orthopaedic Department with Orthopaedics of the National Medical Research Center for Children’s Health from 2013 to 2018 (after the restructuring of the traumatological and orthopedic Department in 2013) with the use of a personalized multidisciplinary approach to the correction of neurogenic musculoskeletal disorders based on the forecast of motor development. The comparative standardized analysis of motor activity of patients before and after surgery was evaluated dynamically according to a 10-point scale-the Gillette FAQ (Gillette Functional Assessment Questionnaire).

Results. Based on the analysis of functional results, the surgical treatment was concluded to be more effective in group 2, where it was planned based on the prognosis of motor development of a cerebral palsy child. A comparative analysis of the duration of periods of postoperative rehabilitation of patients with musculoskeletal disorders against the background of cerebral palsy showed a significant reduction in the rehabilitation period of patients whose treatment took into account the forecast of motor development according to GMFCS and used simultaneous multi-level surgical interventions.

Conclusion. A multidisciplinary approach to the treatment of this category of patients allowed qualitatively and quantitatively increasing the effectiveness of surgical and reconstructive treatment of children with spastic forms of cerebral palsy.

L.O. Badalyan Neurological Journal. 2020;1(2):92-98
Experience in catering for patients with cerebral palsy during comprehensive rehabilitation at the Federal center
Pak L.A., Makarova S.G., Fisenko A.P., Kuzenkova L.M., Chumbadze T.R.

Introduction. The formation of an adequate diet in children with cerebral palsy (CP) is associated with a number of difficulties, including the assessment of nutritional status and the need for nutrients and energy, the presence of dysphagia and other disorders. At the same time, dietary support for these children is critical for improving their somatic status and, consequently, their rehabilitation potential. According to the 2017 ESPGHNG recommendations, an individual approach is required to optimize dietary measures and monitor their effectiveness in CP children, including evaluating body composition indices. The purpose of the study is to optimize the nutritional support of CP children in conditions of a comprehensive rehabilitation in the Federal center.

Materials and methods. In the study performed in the National Medical Research Center for Children’s Health, there were observed 27 CP children (G80) with concomitant protein-energy malnutrition (PEM), including 11 (40.7 per cent) of girls aged 5-11 years (average age of 7.4 (5.7; 8.0) years). The assessment of anthropometric data was carried out using the software «WHO AnthroPlus», bioimpedance analysis of the component composition of the body was carried out on the device-analyzer «ABC-01 Medass», the assessment of the chemical composition of the diet was carried out using the software “Diet”. Dietary support consisted of correcting the basic diet, prescribing specialized hypercaloric mixtures and medication therapy. Dynamic control of the nutritional status of observed patients was performed after 2 months of complex nutritional correction.

Results. At the beginning of this study, patients were distributed according to the degree of PEM as follows: mild — in 17 (63.0%), moderate — in 5 (18.5%), severe-in 5 (18.5%); after a two-month course of drug therapy and nutritional correction — 22 (81.5%), 2 (7.4%) and 3 (11.1%), respectively. The integrated use of drug therapy and nutritional correction has resulted in 55.5% of patients with rapid improvement in nutritional status, which was manifested by an imroved appetite, weight gain, positive dynamics of anthropometric indices, normalization of the signal, including affecting performance, and thus on the rehabilitation potential of the child.

Conclusion. The obtained data indicate the possibilities of nutritional support in the complex treatment of children with cerebral palsy to be underestimated and indicate the need to include in the diagnostic and treatment algorithms of CP children consultations by a dietitian and appropriate therapeutic measures.

L.O. Badalyan Neurological Journal. 2020;1(2):100-111
Development of the system for registration and monitoring system for children with cerebral palsy in the Tyumen region (CPUP-Tyumen region)
Zmanovskaya V.A., Levitina E.V., Bunkova S.A., Butorina М.N., Kharlamova N.N., Dankov D.M., Кокоrina А.А., Rudzevich I.L., Shusharina V.L., Ushakova S.A.

Introduction. At the present stage in Russia, there is little research to study the patterns, causes, and real needs of people with cerebral palsy (СР). The source of such knowledge is the registers of children with CP. The system for recording and monitoring CP cases, introduced in the Tyumen Region, is an attempt to study the epidemiological characteristics of the population of CP children patients in terms of clinical manifestations and secondary orthopedic problems by creating an up-to-date register.

The aim of the work is to study the epidemiological characteristics of the population of children with cerebral palsy (CP) in the Tyumen region in terms of clinical manifestations and secondary orthopedic problems using a follow-up surveillance programme for people with cerebral palsy (CPUP) for recording and following-up CP cases) in the Tyumen region

Material and Methods. 685 children (80% of the total number of CP children patients in the region) were registered in the period from January 2014 to December 2016 on the basis of the Children’s Psychoneurological Treatment and Rehabilitation Center «Nadezhda». The Protocol of the survey of children included the collection of demographic information, assessment of functional mobility, global motor function, hand function, communication functions, function of eating and drinking, Protocol of goniometric measurements, determination of spasticity test, interpretation of Х-ray examinations.

Results. The average age of CP children patients accounted for 10.2 ± 9.7 months (58% — boys, 42% — girls). 78% of children had spastic forms of CP, 4% — dyskinetic forms, 3% — ataxic forms, 15% had mixed CP forms. 50% of children had GMFCS IV–V, 31% had MACS I–II, 51% had CFCS IV–V. 28% had normal Reimers index values of less than 33%, 29% — in the range from 33% to 40%, 43% — more than 40%. GMFCS I CP children did not have hip displacement. 12% of GMFCS II children, 36% of GMFCS III children, 59% of children with and 71% of GMFCS V children had more than 40% of the Reimers Index.

Conclusion. CPUP–Tyumen Region was the first register of CP children patients in terms of demographic characteristics, birth history, risk factors for the development of the disease, clinical forms of cerebral palsy, as well as the frequency of secondary orthopedic complications, which became the basis for the development of a set of preventive measures to improve the quality of life of CP patients.

L.O. Badalyan Neurological Journal. 2020;1(2):113-120
Assessment of features of the nutritional status and nutrient requirements in children with cerebral palsy
Makarova S.G., Pak L.A., Fisenko A.P., Kuzenkova L.M.

The energy and nutrient requirements of children with cerebral palsy (СP) have always been discussed among domestic and foreign scientists. A wide range of physical characteristics such as state of muscle tone, dysphagia, pseudobulbar syndrome, hyperkinesia or the lack of physical activity determine individual features of the patients’ nutritional needs. Whereas, underestimation of these needs along with comorbid pathologies (frequent pneumonia, bronchitis, etc.), characterizing this group of patients, can easily lead to the emergence and rapid progression of protein-energy deficiency. In addition, there are also difficulties with the interpretation of indices of a patients’ physical development. In this regard, both special scales for physical development assessment and formulas for individual nutrient and energy requirements calculation have been developed for this category of patients. However, according to recent data, the use of these scales and formulas can lead to underestimation of the nutritional needs of CP children. This, in its turn, can cause protein-energy deficiency, frequently (in 29–66% of cases) found in these patients. Therefore, some principles of diet and nutritional support for CP children are being reviewed now. At the same time, the organization of adequate nutritional support based on modern clinical recommendations and a personalized approach is the key component of the comprehensive treatment of this complex patients’ category. This review contains the description of the current situation, as well as a broad discussion of different approaches based on the international, domestic guidelines and relevant recommendations of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists — ESPGHAN, 2017).

L.O. Badalyan Neurological Journal. 2020;1(2):122-131

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