Efeitos da toxina botulínica sobre o tônus muscular e a mobilidade articular de crianças com síndrome congênita do Zika – Uma série de casos

Resumo

Objetivo Avaliar os efeitos da toxina botulínica (BTX-A) sobre o tônus muscular e mobilidade articular de crianças com síndrome congênita do Zika (SCZ).

Métodos Trata-se de uma série de casos longitudinal realizada em um Centro de Apoio a Criança com Microcefalia, localizado no nordeste do Brasil. A coleta de dados foi realizada a partir dos prontuários dessa instituição, com o registro de informações sobre o tônus muscular e a mobilidade articular passiva, mensuradas pelo menos 3 meses antes e 4 semanas após a aplicação da BTX-A.

Resultados Foram avaliadas 13 crianças (9 meninos) com idade média de 77 ± 7,1 meses. Após a aplicação da BTX-A, foi observada redução bilateral do nível de hipertônia nos músculos flexores do cotovelo (p < 0,01) e adutores de quadril (p < 0,05) bilateralmente.

Conclusão Nenhuma mudança foi observada na mobilidade articular e nenhum efeito adverso foi relatado pelos cuidadores após a aplicação. O uso da BTX-A é capaz de promover a redução do nível de hipertonia de crianças com SCZ, sem impactar a mobilidade articular.

Palavras-chave

artrometria articular - espasticidade muscular - hipertonia muscular - infecção pelo Zika vírus

• Referências

• 1 Melo AS, Aguiar RS, Amorim MM. et al. Congenital Zika Virus Infection: Beyond Neonatal Microcephaly. JAMA Neurol 2016; 73 (12) 1407-1416
• 2 Tavares JS, Gama GL, Dias Borges MC. et al. Classification of Congenital Zika Syndrome: Muscle Tone, Motor Type, Body Segments Affected, and Gross Motor Function. Dev Neurorehabil 2021; 24 (05) 296-302
• 3 Melo A, Gama GL, Da Silva Júnior RA. et al. Motor function in children with congenital Zika syndrome. Dev Med Child Neurol 2020; 62 (02) 221-226
• 4 Pereira HVFS, Dos Santos SP, Amâncio APRL. et al. Neurological outcomes of congenital Zika syndrome in toddlers and preschoolers: a case series. Lancet Child Adolesc Health 2020; 4 (05) 378-387
• 5 Singhi P, Ray M. Botulinum toxin in children with cerebral palsy. Indian J Pediatr 2004; 71 (12) 1087-1091
• 6 Dietz V, Sinkjaer T. Spastic movement disorder: impaired reflex function and altered muscle mechanics. Lancet Neurol 2007; 6 (08) 725-733
• 7 Multani I, Manji J, Hastings-Ison T, Khot A, Graham K. Botulinum Toxin in the Management of Children with Cerebral Palsy. Paediatr Drugs 2019; 21 (04) 261-281
• 8 Jabbari B, Comtesse SM. Botulinum Toxin Treatment of Motor Disorders in Parkinson Disease-A Systematic Review. Toxins (Basel) 2023; 15 (02) 81
• 9 Ostrowski H, Roszak J, Komisarek O. Botulinum toxin type A as an alternative way to treat trigeminal neuralgia: a systematic review. Neurol Neurochir Pol 2019; 53 (05) 327-334
• 10 Picelli A, Filippetti M, Sandrini G. et al. Electrical Stimulation of Injected Muscles to Boost Botulinum Toxin Effect on Spasticity: Rationale, Systematic Review and State of the Art. Toxins (Basel) 2021; 13 (05) 303
• 11 Kawamura A, Campbell K, Lam-Damji S, Fehlings D. A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity. Dev Med Child Neurol 2007; 49 (05) 331-337
• 12 Aktaş E, Ömeroğlu H. Botulinum toxin type A injection increases range of motion in hip, knee and ankle joint contractures of children with cerebral palsy. Eklem Hastalik Cerrahisi 2019; 30 (02) 155-162
• 13 Sales HF, Cerqueira C, Vaz D. et al. The impact of botulinum toxin type A in the treatment of drooling in children with cerebral palsy secondary to Congenital Zika Syndrome: an observational study. Neurol Res 2021; 43 (01) 54-60
• 14 Armani-Franceschi G, Luz C, Lucena PH. et al. Botulinum Toxin Type A in the Spasticity of Cerebral Palsy Related to Congenital Zika Syndrome: An Observational Study. Dev Neurorehabil 2022; 25 (03) 162-169
• 15 Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67 (02) 206-207
• 16 Marques AP. Manual de goniometria. 2a. ed.. Barueri: Manole; 2003
• 17 Bohannon RW. Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing 1997; 26 (01) 15-19
• 18 Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Task Force on Childhood Motor Disorders. Classification and definition of disorders causing hypertonia in childhood. Pediatrics 2003; 111 (01) e89-e97
• 19 Lundy CT, Doherty GM, Fairhurst CB. Botulinum toxin type A injections can be an effective treatment for pain in children with hip spasms and cerebral palsy. Dev Med Child Neurol 2009; 51 (09) 705-710
• 20 Thorley M, Donaghey S, Edwards P. et al. Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial. BMC Pediatr 2012; 12: 120
• 21 Cosgrove AP, Corry IS, Graham HK. Botulinum toxin in the management of the lower limb in cerebral palsy. Dev Med Child Neurol 1994; 36 (05) 386-396
• 22 Pin TW, Elmasry J, Lewis J. Efficacy of botulinum toxin A in children with cerebral palsy in Gross Motor Function Classification System levels IV and V: a systematic review. Dev Med Child Neurol 2013; 55 (04) 304-313
• 23 da Fonseca JO, de Oliveira Vianna RA, Carvalho FR. et al. The Hip of Children with Congenital Zika Syndrome: A Prospective Observational Study. J Pediatr 2023; 256: 27-32
• 24 Pone MVDS, Gomes da Silva TO, Ribeiro CTM. et al. Acquired Hip Dysplasia in Children with Congenital Zika Virus Infection in the First Four Years of Life. Viruses 2022; 14 (12) 2643
• 25 Smith LR, Lee KS, Ward SR, Chambers HG, Lieber RL. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. J Physiol 2011; 589 (Pt 10): 2625-2639
• 26 Willerslev-Olsen M, Lorentzen J, Sinkjaer T, Nielsen JB. Passive muscle properties are altered in children with cerebral palsy before the age of 3 years and are difficult to distinguish clinically from spasticity. Dev Med Child Neurol 2013; 55 (07) 617-623
• 27 Howard JJ, Herzog W. Skeletal Muscle in Cerebral Palsy: From Belly to Myofibril. Front Neurol 2021; 12: 620852
• 28 Yana M, Tutuola F, Westwater-Wood S, Kavlak E. The efficacy of botulinum toxin A lower limb injections in addition to physiotherapy approaches in children with cerebral palsy: A systematic review. NeuroRehabilitation 2019; 44 (02) 175-189