Multilevel Botulinum Toxin Type A as a Treatment for Spasticity in Children with Cerebral Palsy: A Retrospective Study

INTRODUCTION: Cerebral palsy is the most common cause of physical disability in children. Spasticity is a disabling clinical symptom that is prevalent among patients suffering from cerebral palsy. The treatment of spasticity with botulinum toxin type A (BTX-A) is a well-established option in the interdisciplinary management of spasticity, providing focal reductions in muscle tone in cerebral palsy patients. OBJECTIVE: The aim of this retrospective study was to describe the effect of multilevel BTX-A injections in the lower extremities, focusing mainly on gross motor function and functional status in cerebral palsy patients. METHODS: Data from 71 cerebral palsy patients (64% male, 36% female, mean age 6.7 ±3.2 years) were analyzed retrospectively. We used the Ashworth and Tardieu scales to evaluate the degree of spasticity. Motor function was measured by the Gross Motor Function Measure (GMFM-88), and functional status was classified by the Gross Motor Function Classification System (GMFCS I-V). Multilevel BTX-A injections were applied after sedation and with electrostimulation guidance. The evaluations were repeated every three months, and the patients were followed for six months. RESULTS: We found that the Ashworth and Tardieu scores decreased significantly at the three-month evaluation (p<0.05) but not at the six-month evaluation (p>0.05). Although the improvement in spasticity was not maintained at the six-month evaluation, GMFM-88 scores increased significantly at the three- and six-month assessments. GMFSC levels showed no change in the three- and six-month assessments. CONCLUSION: We believe that a single multilevel BTX-A injection reduces spasticity and improves motor function in children with cerebral palsy

Effectiveness of Functional Electrical Stimulation - Cycling Treatment in Children with Cerebral Palsy

AimThe purpose of this study was to evaluate the effects of functional electrical stimulation (FES) bicycle therapy system on motor function, gait pattern, spasticity, daily living activities, and aerobic capacity in children with cerebral palsy (CP) and to compare the results with sham stimulation and standard treatment.MethodsPatients with cerebral palsy who received botulinum toxin type-A injections to lower extremities and those with Gross Motor Function Measure Classification System (GMFCS) levels I – III, were included in the study. Twenty-five patients were randomly assigned into three treatment groups for 4-weeks: Group 1, FES-cycling and standard treatment; Group 2, Sham stimulus FES-cycling and standard treatment; Group 3, Standard treatment. Clinical assessment tools included the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Pediatric Functional Independence Measure (WeeFIM), GMFCS, Gross Motor Function Measure-88 (GMFM-88), selective motor control tests, 6-minute walk test, and Visual Gait Analysis (VGA).ResultsIn all groups, there were significant improvements in MAS, MTS, WeeFIM, GMFM-88, 6-minute walk test, and VGA scores. No changes in GMFCS levels were observed in any group. At the end of the study, there was no significant difference among the groups in terms of any clinical assessment parameter.ConclusionsAll groups showed statistically significant improvements in motor function, walking pattern, spasticity, daily living activities, and aerobic capacity in patients with CP following the rehabilitation period. Although FES-cycling demonstrated no superiority over the other approaches and provided no additional benefit to the results, FES appears to be safe and well-tolerated in children with CP, at least as much as standard exercise treatment

Splinting in carpal tunnel syndrome—should we use it during the daytime?

Abstract Background Splinting is frequently used in the treatment of CTS (carpal tunnel syndrome) and is mostly preferred at night. On the other hand, there are some studies suggesting the use of splint throughout the day. However, there is still no consensus. The aim of this randomized controlled study was to evaluate the effects of day and night splinting in terms of pain, symptom severity, functional status, and quality of life in patients with CTS. Results Seventy wrists of 46 patients with CTS were evaluated. In the day-night splint group, according to without splint group and night-only splint group, a statistically significant improvement was found in terms of pain level assessed by Visual Analogue Scale (p = 0.001, p = 0.015, respectively), Boston Carpal Tunnel Questionnaire-Functional Severity Scale (p = 0.004, p = 0.020, respectively), The Nottingham Health Profile-pain (p = 0.001, p = 0.003, respectively), The Nottingham Health Profile-social isolation (p = 0.001, p = 0.001, respectively), and The Nottingham Health Profile-total score (p = 0.001, p = 0.012, respectively). In addition, it was found that even the use of splint only at night resulted in a significant reduction in pain compared to the control group (p = 0.018). Conclusions Continuation of splinting as much as possible during the daytime in addition to night splinting is beneficial in terms of pain, nocturnal symptoms, functionality, and quality of life

The contribution of thiamine, pyridoxine and cyanocobalamine combination on nerve regeneration in rats with experimentally induced sciatic injury

Ergin, Irem/0000-0003-2373-5133; Besalti, Omer/0000-0002-7819-9094WOS: 000253195400016The aim of this study was to investigate the role of thiamine, pyridoxine and cyanocobalamine combination on nerve regeneration after experimentally induced crush injury in thirty adult, male wistar rats. Sciatic function index and Toe spreading reflex and nerve conduction studies on exposed sciatic nerve were carried out before sciatic crush injury and after three weeks of treatment. The experiment group received thiamine (33 mg kg(-1)), pyridoxine (33 mg kg(-1)) and cyanocobalamine (0.5 mg kg(-1)) injections intramuscularly for 3 weeks and the control group received equal volumes of saline injections. Toe-spreading reflex were better in the experiment group than the controls after treatment (p<0.05). There was no significant difference in regard to DL, DCMAP, PCMAP and NCV between both groups (p<0.05). In conclusion the beneficial effect of thiamine, pyridoxine and cyanocobalamine combination was not found in regard to the electrophysiological parameters measured. However clinical improvement was superior in the experiment group than the control group

Outcomes of Botulinum Toxin Type A Injection Followed by Rehabilitation in Cases of Cerebral Palsy With Upper Extremity Involvement

Karaca, Burcu/0000-0003-2401-5445WOS: 000370429700014PubMed: 26239492We evaluated the efficiency of botulinum toxin type A injection followed by a rehabilitation program including individual therapy, group therapy, and occupational therapy in cases of cerebral palsy with upper extremity involvement. A total of 29 injections were performed on 25 patients, and the patients were placed on rehabilitation program. At 3-month and 6-month assessments, there was a significant improvement in lateral grip strength, 9 Hole Peg test, Upper Limb Physician's Rating Scale and pediatric functional independence measure total scores. There were significant decreases in active range of motion in elbow extension, supination, and wrist extension, and Modified Ashworth Scale in elbow flexion, elbow pronation, and wrist flexion at 6-week, 3-month, and 6-month assessments. Combination of group therapy with traditional therapy methods after injection is effective in cases of cerebral palsy with upper extremity involvement

Assessment of crustal thinning and tectonic stress distribution of Gulbahce fault zone and its surroundings (Izmir, West Turkiye) using gravity and magnetic anomalies

Gulbahce Fault Zone (GFZ) is a significant tectonic structure and seismic source for Izmir city and its surroundings. The major earthquakes occurred at the surroundings of GFZ are 2005 Seferihisar, 2020 Samos Island-Aegean Sea and 2021 Seferihisar earthquakes. In this study, the crustal thinning and tectonic stress distribution of GFZ and its surroundings were analyzed by using the new gravity and magnetic data. The correspondence analysis was applied by appraising together the magnetic and free-air anomaly data. Moreover, the average density of the subsurface structure was calculated by applying the Parasnis method. The deviatoric stress calculation was executed and the change of the physical properties that controls the gravity and magnetic anomaly of the crustal structure of the GFZ and its surroundings from north to south was investigated. Therefore, the average density values, which were obtained from gravity anomalies, were computed as 2.59 gr / cm(3) in the north of the study region and it decreased to 2.06, 1.8 and 1.49 gr / cm(3) towards to the south. The free-air gravity anomaly values were between 0-70 mGal and the magnetic anomalies were between -450-150 nT. The deviatoric stress values were between -0.2-0.1 MPa

Importância do período de silêncio cutâneo na fibromialgia e sua relação com as características da doença, distúrbios psicológicos e qualidade de vida dos pacientes

INTRODUÇÃO: O período de silêncio cutâneo (PSC) é um reflexo protetor inibitório da coluna vertebral e seus aferentes consistem em fibras nervosas A-delta. Nosso objetivo foi avaliar pacientes com fibromialgia (FM) e controles saudáveis para determinar as diferenças entre os grupos em relação à duração e latência do PSC, e quando presente, determinar se há alguma relação com as características da doença, distúrbios psicológicos e qualidade de vida. MATERIAIS E MÉTODOS: Trinta e dois pacientes com FM e 32 voluntários saudáveis foram incluídos no estudo. Os dois grupos foram comparados em relação à latência e duração do PSC em ambos os membros superiores e inferiores. Características da doença, distúrbios psicológicos e qualidade de vida dos pacientes foram avaliados utilizando o Fibromyalgia Impact Questionnaire (FIQ), e o Short Form-36 (SF-36). Os pacientes com medida de PSC igual ou inferior às do grupo controle foram comparados com aqueles com valores mais elevados do que os controles em termos de características da doença, estado psicológicos e qualidade de vida. RESULTADOS: Latências significativamente prolongadas de PSC nos membros superiores e inferiores foram determinadas em pacientes comparados com os controles. Observou-se que a prolongamento da latência do PSC no membro inferior estava associado com a gravidade da doença e incapacidade funcional. CONCLUSÕES: Latências do PCS nos membros superiores e inferiores em pacientes com FM são mais longas do que em voluntários saudáveis. Além disso, o prolongamento da latência do PSC no membro inferior está associado com a gravidade da doença e incapacidade funcional física

Evaluation of macular thickness change after inferior oblique muscle recession surgery

Purpose: This study aimed to evaluate the changes in macular thickness following inferior oblique muscle recession surgery. Materials and Methods: Thirty-eight eyes from 21 patients undergoing ocular muscle surgery were included. Patients were grouped into three groups based on the type of surgical intervention: Group I (n = 12), inferior oblique recession surgery alone; Group II (n = 12), inferior oblique plus horizontal muscle surgery; Group III (n = 14), horizontal muscle surgery alone. Each eye was scanned using the optical coherence tomography (OCT) device preoperatively and on the first postoperative day to measure macular thickness. Results: Following surgery, a significant increase in foveal thickness occurred in Group I (P < 0.05) and Group II (P < 0.01). In addition, a statistically significant difference was observed between the groups with regard to the increase in foveal thickness (P = 0.016), with significantly lower changes in Group III. Conclusion: Our findings suggested that inferior oblique muscle recession surgery is associated with an increase in macular thickness

A triazoloquinoxaline and benzodithiophene bearing low band gap copolymer for electrochromic and organic photovoltaic applications

A new triazoloquinoxaline and benzodithiophene based copolymer was synthesized to investigate its electro-chemical, optical and photovoltaic behaviors. According to the polymer design, combination of two acceptor units (benzotriazole and quinoxaline) which contribute imine bonds to the structure and a triazoloquinoxaline unit for enhancing electron accepting ability was pursued. As a result of electrochemical studies, the copolymer PTQBDT has a low lying HOMO energy level as - 5.23 eV which increases the chemical stability of the resulting polymer and leads to a higher V-oc. In addition, the copolymer has an ambipolar character with two well-defined redox couples in the n-doped state and multichromic behavior. In the context of optical studies, PTQBDT has wide absorption range in the visible region with a tail in the NIR region, which yields a low band gap of 1.20 eV. Organic photovoltaic devices were designed using PTQBDT (the electron donor) and PC71BM (the electron acceptor) for the preliminary studies. The resulting device exhibits a power conversion efficiency of 2.0% with a current density of 8.07 mA cm(-2), an open-circuit voltage of 0.45 V, and a fill factor of 55%. The carrier mobility of the PTQBDT was calculated as 3.00 x 10(-3) cm(2) V-1 S-1 via space-charge-limited current (SCLC) method