Aspectos funcionais de crianças com paralisia cerebral submetidas à aplicação de toxina botulínica

Abstract

Introduction: Children with cerebral palsy (CP) can suffer functional limitations from spasticity and sialorrhea. Botulinum toxin type A (BTA) is a medication that can be applied to improve functionality. Objectives: To evaluate the functional aspects before and after the application of BTA in children with CP, according to the functional domains, followed from January 2015 to December 2020 at the Martagao Gesteira Institute of Childcare and Pediatrics (IPPMG) of the Federal University of Rio de Janeiro (UFRJ) and at the Institute of Physical Medicine and Rehabilitation (IMREA) of the Hospital das Clinicas of the Faculty of Medicine of the University of Sao Paulo (USP). Methods: Observational retrospective cohort study of children with CP aged 4 to 14 years followed at two Brazilian university centers from January 2015 to December 2020, according to: target functional domains, age group, biological sex, etiology of neurological sequelae, motor involvement, type of BTA, cumulative dose, effectiveness and safety, in addition to the analysis of the family profile and the perception of improvement of these caregivers. A Tonus Variation Index (TVI) was created and used before and after each BTA application according to the Modified Ashworth Scale by target functional domains: orthostatism and gait; manual activities; use of orthoses; hygiene; sialorrhea; analgesia; and prevention of deformities. Results: Seventy patients were included, the majority of whom were male (62.9%), with a mean age of 7.79 years, and 117 TBA applications were performed. The most common etiology was neonatal asphyxia and, regarding motor impairment, quadriplegics were predominant. There were higher TVIs and greater effectiveness in functional domains "Manual activity" and "Use of orthosis", with the lowest effectiveness being "Orthostatism and gait".The "Manual activity" and "Hygiene" domains were more effective in the age group 11-14 years. The comparison between the sexes for the targeted domains was not significant. . Most were undergoing physical therapy and/or occupational therapy. There was greater effective for those undergoing physical therapy in the "Orthostatism and gait", "Analgesia" and "Prevention of deformities" domains; and for those undergoing occupational therapy, in the domain "Analgesia". Applications with BTA AbobotulinumtoxinA were more effective than with BTA OnabotulinumtoxinA overall and in the "Orthostatism and gait", "Analgesia" and "Prevention of deformities". There were no reports of adverse effects. Conclusion: BTA applications are safe and effective, and should be focused on functional domains target. This study proposed the TVI, which can be used as a parameter for evaluating therapeutic response depending on further studies involving a larger number of children and adolescents with CP.Também disponível on-line.