1. The Pediatric Encephalopathy Treatment and Rehabilitation Center of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine took the lead in carrying out neuroelectric stimulation guided botulinum toxin A injection technology in the province in 2006, and has so far injected more than 200 cases with good efficacy and no adverse reaction in any case.
2 Mechanism of action
Botulinum toxin acts on peripheral nerve endings, nerve-muscle contact points, i.e. synapses, and inhibits the release of acetylcholine from presynaptic membranes, thus causing relaxation paralysis of muscles and relieving spasm and tonicity. Li Huawei, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
3.Botulinum toxin injection
About 70% of children with cerebral palsy are suffering from spastic cerebral palsy. Spastic cerebral palsy highlights increased muscle tone, leading to motor dysfunction, so reducing muscle tone and promoting motor development is the focus of treatment. By injecting Botox, muscle spasm can be relieved quickly and muscle tone can be reduced. However, botulinum toxin injection is very demanding.
3.1 Case selection
Age 1-5 years old, with certain motor function, autonomous motor ability, spastic cerebral palsy or tardive cerebral palsy with focal muscle spasm and dysfunction is preferred, and no heart, liver, kidney and blood system diseases, no fever and no infection are applied.
3.2 Timing of injection
When the child is able to stand or walk alone, but has abnormal walking posture due to increased muscle tone, Botox can be injected to reduce muscle tone and improve abnormal posture. If a child is unable to take care of himself/herself due to increased muscle tone, Botox can be injected to reduce muscle tone to facilitate care or nursing. Or, by reducing muscle tone, it can provide a strong basis for rehabilitation training.
3.3 Injection site selection
A detailed functional assessment of the child by the physician is required to identify the muscles that cause increased dysfunctional muscle tone as the target muscles for injection.
3.4 Injection method
In many cases, blind injection is done with bare hands, which has the advantage of short injection time and relatively little pain for the child, but the disadvantage is that the injection site is not always accurate and affects the efficacy. The botulinum toxin A injection technique under the guidance of neuroelectric stimulator carried out in our center has the characteristics of simple operation, accurate positioning and remarkable efficacy, but the disadvantage is that the child will experience pain.
3.5 Injection dose
6-12 units/kg. By assessing the different severity of spasm of each target muscle and the different size of the muscle, the drug is reasonably distributed to achieve the best therapeutic effect.
3.6 Post-injection treatment
After botulinum toxin injection, it is very important to strengthen the rehabilitation function training. After botulinum toxin injection, the effect usually appears about 2 days after injection, reaches the maximum effect from 4 days to 1 week, and the effect is maintained for 3-6 months. The drug only provides the opportunity for rehabilitation treatment in a period of time, without post-injection rehabilitation training, the drug injection is just a waste of money. After the injection, training should be strengthened, massage, exercise therapy, spastic muscle physiotherapy, etc. For some appearing joint deformation or to prevent joint deformation, suitable orthopedic brace should be worn after the injection to correct, reduce or prevent joint deformation.
4.Adverse reactions
Botulinum toxin is very toxic, 1g can kill tens of thousands of people, but it is not toxic to neuromuscular. The only indicator to decide whether Botox is an angel or a devil is the dosage. Botox as a drug, each bottle contains 100 units, equivalent to 5ng, 1ng = 10-9 g; intravenous injection of 3000 units can cause the death of 70kg adults. The injection of botulinum toxin in children with cerebral palsy is mainly localized and rarely spreads to the blood, and the dosage is very small each time (6-12 units/kg), so there are few adverse reactions, except for pain during injection. So far, more than 200 cases have been injected in our center, and no adverse reactions have occurred in any of them.
Botulinum toxin is the most dazzling means of treating spasticity and hypertonia, and botulinum toxin injection is a science and technology, but also an art. Proper application can achieve immediate results.