Uso da toxina botulínica tipo A no tratamento da espasticidade em crianças com paralisia cerebral: uma revisão da literatura

Abstract

Introduction. For just over two decades, botulinum toxin has been used as part of a multimodal treatment to reduce muscle tone in children with spastic cerebral palsy (CP). It is a neuromuscular blocker, type A (BoNT-A) being the most used in clinical practice because it is the most potent and has the longest duration. In addition to improving motor function, it has been postulated that its use allows the learning of more normal patterns of movement, minimizing the possibility or postponing of surgical interventions. Objective. To review the scientific literature on the treatment of spasticity in children with cerebral palsy with botulinum toxin type A. Methodology. The electronic databases of PubMed, SciELO, Science Direct, Google Scholar and CAPES Periodicals were searched, where studies published in the last 6 years were selected, limited to randomized and double-blind clinical trials, systematic reviews and meta-analyses. Therefore, we sought to make a synthesis of the evidence accumulated over this period. Results. Ten articles were included in this review, five were systematic reviews, two were meta-analyses and three were randomized, double-blind clinical trials, which presented the minimum therapeutic dose, dilution, the impact of single and repeated injections, selection of muscles and points to be applied, with a focus on the pediatric and youth population. Conclusion. The use of BoNT-A provided a significant improvement on the spasticity and functionality of children with spastic CP, within a period of up to 3 months after its application. It can be considered a safe and effective treatment option, but limited by presenting a temporary mode of action as a focal spasticity treatment and restrictions on total dose distributed per session. Furthermore, suggestions for future studies are also discussed.