A Potential New Indication for Botulinum Toxin Injection: A Case Study of Spasticity with Mirror Movements
نویسندگان
چکیده
A 17‐year‐old male patient who was diagnosed with spastic cerebral palsy in his childhood came for seeking management of spasticity in his right upper limb. We found that he had typical presentations of MM in his right upper limb. Every time, when he was trying to extend his left wrist and fingers, his right wrist and fingers extended simultaneously. However, active motion of the right wrist and fingers was limited. He also had a flexed spastic elbow. Botulinum toxin type A (BTA, Botox, Allergan) was injected into the affected muscles, including the right biceps brachii, brachioradialis, flexor digitorum superficialis and profundus, as well as flexor carpi ulnaris and radialis, 50 units per muscle (300 units in total) under electromyographic guidance. Following the injections, stretching and extensive physical and occupational therapy were performed for 4 weeks. After these treatments, the spasticity in his right limb reduced, from modified Ashworth scale Grade 1+ to 1 in the elbow, Grade 2 to 1 in the wrist, and Grade 1+ to 1 in the fingers. The active range of motion improved significantly in his right elbow extension, from 30° to 10°, and in his right wrist extension, from 20° to 30°. Moreover, he was capable of extending his right wrist independently, released from the control of the left limb. By using the Quality of Upper Extremity Skills Test scale,[3] obvious functional improvements were observed with an increase of 20 points in the total score (from 48.89 to 67.67). For each subdomain, the score increased from 53.12 to 62.50 in dissociated movement, from 44.44 to 50.00 in grasps, from 48.00 to 79.00 in weight bearing, and from 50.00 to 79.16 in protective extension.
منابع مشابه
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عنوان ژورنال:
دوره 129 شماره
صفحات -
تاریخ انتشار 2016