Serebral palsi tedavisinde yüksek doz botulismus Toxin Tip-A tedavisi ve etkinliğinin araştırılması
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Abstract
Serebral palsi, <;ocukluk donemindeki aglr fiziksel yetersizligin slk goriilensebeplerindendir. Spastisite, serebral palsili bir<;ok hastada, yaygm olup fizikselsorunlara sebep olmaktadlr. Spastisite tedavisi, fonksiyonel kapasiteyi artmna verahatslzhgl giderme ama<;lanna yonelik olarak semptomatik yaplhr. Oral uygulananila<;lara ek olarak, intramuskiiler kemodenervasyon ajanlanyla yapllan spastisitetedavisi daha da yaygmla~ml~tIr. Spastisite tedavisi i<;in kullanIlan <;ogu oral ila<;lar,<;ocuklarda, ozellikle serebral palsili <;ocuklarda yeterince ara~tlTIlmaml~tIr. Serebralpalsili <;ocuklar i<;in elde mevcut medikal miidahalelere ek olarak, son zamanlar daBotulinum toksini tip-A (BTX-A), spastisitenin farkll bir tedavi yolu olarak rnzlakabul gormektedir. Pediatrik hastalardaki ilk kullaruml, 1993'debildirilmi~tir. BTXA'ninklinik etkilerinin, azalml~ spastisite ve artml~ hareketlilik oldugubilinmektedir. Bununla beraber, BTX-A'nm optimal dozunun nasIl saptanmaslgerektigi konusunda klinisyenler arasmda ortak bir konsensus mevcut degildir.Aynca<;ocuklarda BTX-A'nin dozu konusunda standart bir gori1~ yoktur. Viicut aglrhglkilogram ba~ma 2-6 Unitelik dozlardan; maksimum 29Unite/kg'lik total doza kadarkullanlldlgl bildirilmi~tir. Buna ragmen, <;ocuklardaki doz konusunda ortak hir gorii~mevcut degildir. ~imdiki uygulama BTX-A'yi ge<;mi~te oldugundan daha yiiksekdozda enjekte edilmesi ~eklindedir. Bu <;ah~mada, rehabilitasyon merkezlerindenmerkezimize gonderilen serebral palsili (SP) tamh ve spastik ekinoz deformitesi alantoplam 12 hastaya 25 U/kg BTX-A tedavisi uygulanllml~ ve daha soma hastalarmklinik yanltlan 6 ay boyunca incelenmi~tir. Yiiksek dozda BTX-A tedavisinin, dahaemin oldugu, daha etkili oldugu, <;ocuklar tarafmdan daha iyi tolere edildigidii~iiniildiigii i<;in daha sIkhkla kullanIlmaktadlr. Kas spastisitesi degi~ik hastalardafarkll etki gosterdigi i<;in tedavide BTX-A dozunun titrasyonu gereklidir. BTX-A'nindozajl hastaya gore uygun dozlarda ayarlanmalldlrANAHTAR S6ZCUKLER: Botulinum toksini, serebral palsi, medikal tedavi Cerebral palsy is the most common cause of severe physical disability in childhood.Spasticity is a common and disabling symptom for many patients with cerebral palsy.Therapy for spasticity is symptomatic with the aim of increasing functional capacityand relieving discomfort. Spasticity treatment by orally administered drugs andintramuscular chemodenervation agents has become more frequent. Most oralmedications to treat spasticity have been inadequately studied in children, especiallythose with cerebral palsy. Since its first use in pediatric patients, reported in 1993.Botulinum toxin (BTX-A), a relatively recent addition to the available medicalinterventions for children with cerebral palsy, has rapidly gained acceptance as atreatment of spasticity. The clinical effects of BTX-A have been reported to includedecreased spasticity and increased range of motion Howeyer, no consensus existsamong clinicians about how an optimal dose of BTX-A should be detennined andthere are no standard guidelines on doses of BTX-A in children. Doses of 2-6 VI kgbodyweight with a maximum total dose of 29V/kg have been reported. Although,there are no standard guidelines on doses in children. The current practice is to injectBTX-A higher doses than reported in the past. In this study, 12 patients withcerebral palsy and spastic eqinus foot defonnity from rehabilitation centers weretreated with BTX-A in the dosage of 25 V/kg. After the single dose of BTX-A,patients were followed up total of 6 months and clinical improvement were obseryed.Larger dose of BTX-A is used more frequently which is considered safe, moreeffective, better tolerated by children. Titration of the dose of BTX-A is necessarybecause muscle spasticity affects different patients in different ways. The dosage ofBTX-A must be individualized for each patient.KEY WORDS Botulinum toxin, cerebral palsy, medical treatment.
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