Botulinum Toxins, Type A ; therapeutic use ; Cerebral Palsy ; physiopathology ; rehabilitation ; Child ; China ; Humans

Child ; Humans ; Motor Skills Disorders ; diagnosis ; therapy

Objective To compare the effect of botulinum toxin A(BTX-A)applied according to experi- ence with its effect when the application is guided by electrical stimulation on spasticity in the ankle plantarflexors of children with cerebral palsy(CP).Methods Forty-five children with CP were randomly assigned into 2 groups to receive injections of BTX-A guided by electrical stimulation,or injections of BTX-A guided by experience.All chil- dren received a local injection in the ankle plantar flexors.Physiotherapy and ankle-foot orthoses were applied by a physical therapist 3 days after the BTX-A injections.After the first 10 days,the therapy was administered by the patient's family.Clinical assessments included the patient's passive range of movement(PROM),scoring on the Ash- worth scale(MAS),the composite spasticity scale(CSS),and the D and E dimensions of the gross motor function measure(GMFM),and walking velocity(WV).Assessments were performed before treatment and at 3 days,2 weeks,1,2,and 3 months following the injection with BTX-A.Results All children showed significant decrease in spasticity(PROM,MAS and CSS)after 3 days.The improvement was maintained at 3 months.When compared with the results before the injection,the improvements in standing and walking(GMFM)and in walking velocity were statistically significant after 2 weeks of treatment for both groups,and were maintained at 3 months.The differences in PROM and CSS scores at 3 days,2 weeks,1,2,and 3 months following the injection were statistically significant between the 2 groups.Significant differences were also found between the 2 groups in MAS scores at 3 days,2 and 3 months after treatment,and in GMFM and WV at 2 and 3 months after treatment.Conclusions A BTX-A injec- tion,whether guided by electrical stimulation or experience,in combination with physiotherapy,can reduce spasticity in the ankle plantarflexors of ambulant children with CP and improve their functional performance.BTX-A injection guided by electrical stimulation was more effective than an injection guided by experience.

ObjectiveTo explore the effect and safety of intravenous sodium valproate in treatment of pediatric patients with status epilepticus (SE).MethodsTwenty-five children suffering from convulsive SE were treated with intravenous sodium valproate after failure of the conventional treatment, in a dose of tolerability 15 mg/kg and 1～2 mg/kg daily.ResultsIn 25 cases, there were 23 cases (92%) with ≥50% seizure reduction and 11 cases (44%) with complete cessation. Except for winking in 7 cases (28%), no other adverse effects had been found.ConclusionIntravenous sodium valproate is effective and safe on pediatric patients with SE who are resistant to conventional drugs.

0.05).Compared with the CSS,GMFM and WV before treatment,there were statistically difference after 6 and 12 weeks treatment in two groups(Pa

OBJECTIVETo study the features of interictal epileptiform discharges (IED) during sleep and wakefulness in children with epilepsy.

METHODSThe polysomnography, active EEG and video EEG were performed on 48 children with epilepsy during the whole night, and wakefulness of pre- and post-sleep. The epileptiform sharp/spike discharge indexes during sleep and wakefulness were recorded. The positive rate of IED in focal and generalized epilepsy was compared.

RESULTSOf the 48 patients, 25 showed IED, including 9 cases (36.0%) in the generalized seizure group and 16 cases (64.0%) in the focal seizure group (P<0.05). The epileptiform sharp/spike discharge indexes in the whole non-rapid eye movement (NREM) sleep stage (stages S1-S4: 21.13+/-19.96, 19.59+/-17.76, 22.85+/-18.99, and 20.37+/-16.63) were significantly higher than that in the wakefulness stage (8.20+/-6.21) (P<0.05). The discharge index in the S3 stage during NREM sleep was higher than that during the rapid eye movement (REM) sleep (22.85+/-18.99 vs 12.91+/-10.95; P<0.05).

CONCLUSIONSThe positive rate of IED in the focal seizure group was higher than that in the generalized seizure group. Sleep, especially NREM sleep, facilitates IED in children with epilepsy.

Child ; Child, Preschool ; Electroencephalography ; Epilepsy ; physiopathology ; Humans ; Polysomnography ; Sleep ; physiology ; Wakefulness ; physiology

OBJECTIVETo compare the effects of botulinum toxin A (BTX-A) injection guided by electric stimulation combined with physiotherapy, with physiotherapy only on the spasticity of the ankle plantar flexor in children with cerebral palsy (CP).

METHODSAfter signing the informed consent, 43 children with CP, aged 52.4 +/- 13.2 months (35 to 82 months), were randomly assigned into 2 groups, (1) BTX-A group (n = 23) treated with BTX-A injection guided by electric stimulation and (2) physiotherapy alone group (n = 20). Children in BTX-A group received injection of HengLi BTX-A in the ankle plantar flexors. A maximum dose of 12 units of BTX-A per kilogram body weight and maximumly 10 units of BTX-A per site were administered. Localization technique was the use of electrical stimulation guidance. Physiotherapy and ankle-foot orthosis were applied to children at 72 hours after injection in BTX-A group and at the time of being recruited into physiotherapy group. Ten days after entering into the study, the program was applied by the parents. Demographic data, including age, gender, number of the spastic lower limbs, affected side (left or right) were recorded. Clinical assessments included the range of passive movement (PROM) measured by goniometer while children maintained the knee extended, modified Ashworth scale (MAS), composite spasticity scale (CSS), D and E dimensions of the Gross Motor Function Measure (GMFM), and walking velocity (WV) was determined before treatment and at 2 weeks, 1, 2, and 3 months after treatment.

RESULTSNo statistically significant differences were found in age, gender, number of the spastic lower limbs, affected side, as well as clinical assessments (PROM, MAS, CSS, GMFM and WV) before treatment between the 2 groups (P > 0.05). All the children showed a reduction of spasticity (PROM, MAS and CSS) after 2 weeks, 1, 2, and 3 months of treatment (P < 0.05). When compared with the baseline findings, the improvement of standing and walking (GMFM), walking velocity were statistically significant after 2 weeks, 1, 2, and 3 months of treatment (P < 0.05). Furthermore, the differences of PROM, MAS and CSS between the 2 groups at 2 weeks, 1, 2, and 3 months examination were also statistically significant (after 3 months of treatment: t(PROM) = 6.48, t(MAS) = 9.74, t(CSS) = 9.59; P < 0.05). The difference in GMFM between the 2 groups was statistically significant (t(1M) = 2.20, t(2M) = 3.26, t(3M) = 4.13; P < 0.05) at 1, 2, and 3 months after treatment. The difference of WV between the 2 groups was statistically significant (t(2M) = 2.12, t(3M) = 2.57; P < 0.05) at 2 and 3 months after treatment.

CONCLUSIONBTX-A injection guided by electrical stimulation in combination with physiotherapy was more effective than physiotherapy alone in terms of reducing spasticity and improving functional performance in standing, walking, walking pattern and velocity on spasticity in ankle plantar flexors of ambulant children with CP.

Ankle Joint ; physiopathology ; Botulinum Toxins, Type A ; administration & dosage ; therapeutic use ; Cerebral Palsy ; drug therapy ; therapy ; Child ; Child, Preschool ; Electric Stimulation Therapy ; Female ; Gait ; Humans ; Male ; Muscle Spasticity ; drug therapy ; therapy

OBJECTIVETo investigate the effects of transcutaneous electrical nerve stimulation (TENS) on motor function in children with spastic cerebral palsy (CP).

METHODSAfter signing the informed consent, 78 children with CP, aged 45.6 +/- 8.5 months (36 to 58 months), were randomly divided into a TENS group (n = 40) and a control group (n = 38). All the subjects received standardized functional exercise program. In TENS group, 2 TENS devices were used and the surface electrodes were applied on the spastic musculotendinous and antagonist muscles in the affected lower extremity. TENS lasted for 20 min per session, 5 days weekly for 6 weeks. After 6 weeks, the functional exercise program was applied by the caregivers. Demographic data were recorded, including age, gender, number of the hemiplegic and diplegic CP, level of gross motor function classification system (GMFCS). Clinical assessments included the composite spasticity scale (CSS), D and E dimensions of the Gross Motor Function Measure (GMFM), and walking velocity was determined before treatment and at 6, 12 and 24 weeks after treatment.

RESULTSNo statistically significant differences were found in age, gender, number of the hemiplegic and diplegic CP, level of GMFCS, as well as clinical assessments (CSS, GMFM and walking velocity) before treatment between the 2 groups (P > 0.05). All the children showed a reduction of spasticity (CSS) after 6, 12 and 24 weeks of treatment (P < 0.05). When compared with the results obtained before treatment, the improvement of standing and walking (GMFM), walking velocity was statistically significant after 6, 12 and 24 weeks of treatment (P < 0.05). Furthermore, the differences of CSS, GMFM and walking velocity between the two groups at 6, 12 and 24 weeks examination were also statistically significant (after 24 weeks of treatment: t value was 8.96, 3.14 and 2.35, P < 0.05, respectively).

CONCLUSIONWhen compared with the control group, 6 weeks of TENS treatment on the affected lower extremity was more effective in terms of reducing spasticity and improving functional performance in standing, walking, and walking velocity in ambulant children with the spastic CP.

Cerebral Palsy ; therapy ; Child ; Electric Stimulation Therapy ; methods ; Female ; Gait Disorders, Neurologic ; therapy ; Hemiplegia ; therapy ; Humans ; Male ; Muscle Spasticity ; therapy ; Transcutaneous Electric Nerve Stimulation ; methods ; Treatment Outcome

OBJECTIVETo evaluate the effect of epilepsy on sleep in children.

METHODSWhole night polysomnography was performed in 48 epileptic children and 12 healthy controls. The 48 epileptic children were divided into focal seizure and generalized seizure groups and into waking seizure and sleeping seizure groups according to the time of occurrence of the seizures. Various parameters of sleep structure were analyzed.

RESULTSThe sleep efficiency of epileptic children was significantly lower than that of the healthy controls (85.4 +/- 8.6% vs 90.9 +/- 5.8%; P < 0.05). The total recording time (TRT) of sleep was significantly longer and the sleep efficiency was significantly lower in the focal seizure group compared to the control group (P < 0.05). The percentage of stage 1 non-rapid-eye-movement sleep (S1 sleep) increased and the percentage of rapid-eye-movement (REM) sleep decreased in the generalized seizure group compared to the control group (P < 0.05). The percentage of S1 sleep increased and both the percentage of REM sleep and the sleep efficiency decreased in the sleeping seizure group as compared with the control group (P < 0.05). There were no significant differences in the parameters of sleep structure between the waking seizure and the control group. Among the sleeping seizure group, the children with generalized seizure showed significantly lower REM sleep percentage and sleep efficiency, and those with focal seizure had significantly longer TRT and higher S1 sleep percentage as compared with the controls.

CONCLUSIONSEpilepsy affects sleep structure of patients, and different types of seizure have different influences on sleep structure. Children with generalized seizure have prolonged light sleep and shortened REM sleep. When generalized seizures occur during waking, the increase of light sleep is more pronounced. While generalized seizures occur during sleeping, REM sleep reduction is more prominent. Children with focal seizures have decreased sleep efficiency. When focal seizures occur during waking, the sleep structure of patients is normal. However, when seizures occur during sleeping light sleep increases and sleep efficiency decreases.

Adolescent ; Child ; Child, Preschool ; Epilepsy ; physiopathology ; Female ; Humans ; Infant ; Male ; Polysomnography ; Sleep Stages ; physiology