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Cerebral Palsy and Botulinum Neurotoxin

Panji Sananta, Alva Pribadi.


Abstract

Cerebral Palsy (CP) is a diverse group of non-progressive neurological disorders caused by damage to the brain during fetal or infant, affecting posture and movement development. The CP's impairment related to spasticity on the musculoskeletal system is progressive and may result in contracture and deformity. Botulinum neurotoxin (BoNT) has been commonly used to reduce muscle spasticity in children with CP, and many studies have supported its efficacy. BoNT blocks the release of acetylcholine in the neuromuscular junction selectively and reversibly, thus reducing muscle overactivity. Several pathologic conditions are treated with BoNT, such as dystonia, spasticity, autonomic disorders, urologic disorders, pain, gastroenterology disorders, depression, and cosmetic uses. Several studies of BoNT treatment in spastic CP have reported positive effects on gross motor function and gait kinematics. However, unresponsive and unsatisfactory outcomes were also declared and presumed due to antibody formation, wrong choice or missed target muscles, inappropriate indications, or a lack of complementary rehabilitation therapy. Even though BoNT treatment in both ambulant and non-ambulant children with CP gives optimistic outcomes in short-term follow-up, it also brings several fatal adverse events. The systemic spread of BoNT affects all cholinergic sphincter functions, including paralysis of the laryngeal and lower oesophageal sphincter, which leads to aspiration of gastric content and respiratory distress. Further studies are necessary to validate the safety and effectiveness of BoNT treatment. The current use of BoNT and its benefit in CP are discussed in this review.

Key words: Cerebral Palsy, Botulinum Neurotoxin, Spasticity, Disability






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