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Evaluation multidimensionnelle dans les indications et bénéfices des injections de toxine botulique chez l’enfant paralysé cérébral / Multidimensional evaluation of the indications and benefits of botulinum toxin injections in children with cerebral palsyChaléat-Valayer, Emmanuelle 05 June 2018 (has links)
La paralysie cérébrale, cause la plus fréquente des déficiences motrices de l’enfant, affecte entre 2,08 et 3,60 enfants/1000 naissances en Europe et aux Etats Unis. La lésion initiale du cerveau immature sur un squelette en croissance est responsable, selon la CIF, d’altération des structures anatomiques et fonctionnelles avec une limitation des activités et de la participation. La toxine botulinique est aujourd’hui le traitement de référence de la spasticité focale chez l’enfant PC car elle est sélective, réversible, sûre et dose dépendante. Toutefois s’il est clair que les injections de TB diminuent les troubles du tonus, la question des indications et des bénéfices fonctionnels mérite encore d’être investiguée. La mise en œuvre de ce traitement se heurte à la difficulté de l’évaluation pour déterminer les indications et les bénéfices, du fait des présentations cliniques très hétérogènes et du contexte de maturation neurologique et de croissance osseuse, et à la dynamique environnementale particulière entre l’enfant et ses parents. Avec pour objectif d’aborder l’évaluation du traitement par TB de manière multidimensionnelle, nous apportons dans ce travail diverses études permettant d’appréhender une approche globale. Cela prend en compte la déficience du MS, du MI, du complexe spino-pelvien, des capacités et de la performance fonctionnelle, et du comportement. Ceci permet d’appréhender in fine la participation et de proposer par des outils standardisés une analyse personnalisée , des conséquences à moyen et long terme des traitements chez un sujet en croissance et en développement. / Cerebral palsy is the most common cause of motor impairment in children, affecting 2.08 to 3.60 children/1000 births in Europe and the United States. Initial injury on an immature brain and a growing skeleton is responsible of altering body functions and structures with a limitation of activities and an impact on participation, according to the ICF. Botulinum toxin has become the standard treatment for focal spasticity in children with CP, as it is selective, reversible, safe and dose dependent. However, while it is clear that BT injections decrease tone disorders, the question of indications and benefits in terms of functional improvement still needs to be investigated. Indeed, the implementation of this treatment meets different issues, including the difficulty of the evaluation to determine the indications and benefits, because of very heterogeneous clinical presentations and the context of neurological maturation and bone growth, but also the difficulty to take into account the particular environmental dynamics between the child and his parents.In order to approach the evaluation of BT treatment in a multidimensional way, we bring with this thesis several studies contributing to a global approach to understand the different aspects of disability in UL, LL or spine, but also to understand the field of activity for the UL in terms of capacities and functional performance, and finally on the level of behavior to better understand ultimately participation. In this context, the main aim of this work is to propose a personalized analysis, using standardized tools, of the medium- and long-term consequences of treatment for a subject in growth and development.
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Correlação entre a espessura da parede vesical e os achados urodinâmicos em pacientes com lesão medular traumática. Avaliação da influência das alterações morfológicas da bexiga nos resultados da injeção de toxina botulínica tipo-A no detrusor / Association between the bladder wall thickness and urodynamic findings in patients with spinal cord injury. Evaluation of the influence of the morphological changes of the bladder on the results of botulinum toxin type-A injection in the detrusorJosé Ailton Fernandes Silva 08 April 2013 (has links)
Medir a espessura da parede vesical (EPV) através da ultrassonografia, correlacioná-la com os parâmetros urodinâmicos e avaliar o papel destes parâmetros para lesão do trato urinário superior. Avaliar também o papel das alterações da forma da bexiga nos resultados de injeção de toxina botulínica tipo-A (BTX-A) no detrusor em pacientes com lesão medular traumática (LMT). Trata-se de dois estudos. O primeiro é um estudo transversal de 272 pacientes com LMT submetidos à ultrassonografia renal e de bexiga e estudo urodinâmico. A parede anterior da bexiga foi medida e comparada com os dados urodinâmicos. A cistografia foi realizada em 57 pacientes. O segundo foi um estudo prospectivo avaliando os resultados da injeção de BTX-A no detrusor em 27 pacientes considerando os achados urodinâmicos (pré e pós procedimento) e as deformidades da bexiga (cistografia). A média da EPV foi de 3,94 mm e foi estatisticamente maior em pacientes com hiperatividade detrusora neurogênica associada à dissinergia vesicoesfincteriana (HDN/DVE), em comparação com aqueles sem DVE (p<0,001). Essa média também foi maior em pacientes com complacência < 20 mL/cmH2O, comparada aos pacientes com complacência ≥ 20 mL/cmH2O (p<0,001). A média da pressão detrusora máxima (Pdet Max) foi estatisticamente maior nos pacientes com refluxo vesicoureteral (RVU) em comparação com aqueles sem RVU (100,7 vs 61,2 cmH2O respectivamente, p=0,022). Pacientes com complacência < 20 mL/cmH2O apresentaram prevalência de hidronefrose 4,2 vezes maior, comparada aos pacientes com complacência ≥ 20 mL/cmH2O. Não houve associação estatística entre EPV e hidronefrose ou RVU. Vinte e sete pacientes foram submetidos à injeção de BTX-A no detrusor. A média de tempo de continência urinária foi de 8 meses. Nove pacientes (33,3%) tinham forma vesical alterada e 8 casos (29,6%) tinham divertículos. A capacidade cistométrica máxima, Pdet max, volume reflexo e complacência não apresentaram diferença significativa na presença de divertículos ou alteração da forma. O aumento da EPV está associado à complacência < 20 mL/cmH2O e HDN/DVE em pacientes com LMT. No entanto, não houve relação entre a EPV e hidronefrose ou RVU. Baixa complacência e HDN/DVE são os principais fatores de risco para dano ao trato urinário superior. A presença de divertículos ou alteração da forma vesical não influenciou nos resultados após injeção de BTX-A no detrusor. / To investigate the ultrasonographic bladder wall thickness (BWT), urodynamic parameters and evaluate the role of such measurements for the upper and lower urinary tract deterioration and also assess the role of changes in bladder shape in the outcome of botulinum toxin type A (BTX-A) into the detrusor in patients with spinal cord injury (SCI). There are two studies. First study was a cross-sectional study involving two hundred and seventy two patients with SCI who underwent renal and bladder ultrasonography and urodynamic evaluation. The anterior bladder wall was measured and compared to urodynamic data. Cystography was done in 57 patients. The second was a prospective study about injection of BTX-A into the detrusor performed in 27 patients considering urodynamic parameters and cystography findings. Mean BWT was 3.94 mm. BWT was statistically higher in patients with neurogenic detrusor overactivity associated to detrusor sphincter dyssynergia (NDO/DSD) and in those with compliance < 20 mL/cmH2O. Patients with low compliance (< 20 mL/cmH2O), had 4.2 times higher prevalence of hydronephrosis, compared to patients with compliance ≥ 20 mL/cmH2O. Mean of Pdet max was statistically higher in patients with vesicoureteral reflux (VUR) compared to those without (100.7 vs 61.2 cmH2O respectively, p=0.022). There was no statistical association between BWT and hydronephrosis or VUR. Twenty seven patients underwent injection of BTX-A into the detrusor. The average time of urinary continence was 8 months. Nine patients (33.3%) had altered bladder shape and 8 cases (29.6%) had diverticula. The maximum cystometric capacity, NDO, reflex volume and compliance showed no statistically significant difference in the presence of diverticula or altered bladder shape. Increased BWT is associated with low compliance and NDO/DSD in patients with SCI. However, there was no relationship between BWT and hydronephrosis or VUR. Low compliance and NDO/DSD are the main risk factors for the upper urinary tract damage. The presence of diverticula or changes in bladder shape did not influence the results after injection of BTX-A into the detrusor.
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Dystonien mit Beteiligung der mastikatorischen Muskulatur -Eine retrospektive Analyse / Dystonias involving masticatory muscles -A retrospective analysisSpecht, Katharina 25 May 2011 (has links)
No description available.
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AVALIAÇÃO DE POTÊNCIA DE TOXINA BOTULÍNICA TIPO A POR ENSAIOS BIOLÓGICOS E MÉTODO POR CROMATOGRAFIA LÍQUIDA EM FASE REVERSA / POTENCY EVALUATION OF BOTULINUM TOXIN TYPE A BY BIOASSAYS AND REVERSE-PHASE LIQUID CHROMATOGRAPHY METHODFreitas, Guilherme Weber de 26 February 2015 (has links)
Botulinum toxin type A (BTTA) is a polypeptide with 1296 amino acids and its used in some pathologies like hyperhidrosis and migraine, but the cosmetic area is the most important application. BTTA is produced from broth-culture synthesized by the Clostridium botulinum as a single peptide with 150 kDa. Reversed-phase liquid chromatography (RP-LC) method was developed and validated for the assessment of botulinum toxin type A in biopharmaceutical formulations. A RP-LC method was carried out on a Zorbax 300 SB C18 column (150 mm x 4.6 mm i.d.), maintained at 45 ºC. The mobile phase A consisted of 0.05 M sodium sulphate buffer, pH 2.8, and the mobile phase B was acetonitrile, run isocratically at flow rate 0.3 mL/min. Cromatographic separation was obtained with retention time of 11.4 min, and was linear over the concentration range of 0.2-100 IU/mL (r2 = 0.9999) with photodiode array (PDA) detection at 214 nm. The limits of detection and quantitation were 0.04 and 0.16 IU/mL, respectively. Specificity was established in degradation studies, which also showed that there was no interference of the excipients. Equally, the accuracy was 100.31% with bias lower than 0.80%. The method was correlated with in vivo and in vitro bioassays. Moreover, the in vitro cytotoxicity test of related proteins and higher molecular weight forms showed significant differences (p <0.05) compared to intact molecule. The validated methods were applied for the determination of BTTA in biopharmaceutical-derived products, giving mean values of the estimated content/potencies 1.16% lower compared to the in vivo bioassay. It is concluded that represents a contribution to establish new alternatives to monitor stability, quality control and thereby assure efficacy of the biotechnology-derived product. / A toxina botulínica tipo A (BTTA) é um polipeptídio constituído de 1296 aminoácidos e é recomendada para patologias, como hiperhidrose e enxaqueca, mas é especialmente usada como cosmético. A toxina botulínica é produzida através do processo de fermentação bacteriana e após sucessivas etapas de purificação resulta em uma proteína com 150 kDa responsável pelo seu efeito biológico. No presente trabalho foi desenvolvido e validado método por cromatografia líquida em fase reversa (CL-FR) para a avaliação de potência de BTTA em formulações de produtos biofarmacêuticos. No método foi utilizada coluna Zorbax 300 SB C18 (150 mm x 4,6 mm d.i.), mantida a 45 ºC. A fase móvel A foi constituída por tampão sulfato de sódio 0,05 M, pH 2,8, e a fase móvel B por acetonitrila, eluídas em vazão isocrática de 0,3 mL/min. O método utilizou detector de arranjo de diodos (DAD) a 214 nm. A separação cromatográfica foi obtida em 11,4 min, sendo linear na faixa de concentração de 0,2-100 UI/mL (r2 = 0,9999). Os limites de detecção e quantificação foram 0,04 e 0,16 UI/mL, respectivamente. A especificidade foi avaliada em estudos de degradação, que também demonstraram que não houve interferência dos excipientes. A exatidão foi 100,31 com bias inferior a 0,80. O método validado foi correlacionado com bioensaios in vivo e in vitro. Além disso, realizou-se o teste de citotoxicidade in vitro das formas degradadas, as quais apresentaram diferença significativa em relação a forma intacta (p <0,05). O método proposto foi aplicado para avaliação da potência de BTTA em formulações biofarmacêuticas, e os resultados foram comparados com o bioensaio in vivo, observando-se diferença das médias de teor/potência de 1,16% inferior para o método cromatográfico. Contribuíu-se assim para estabelecer procedimentos que aprimoram a caracterização ou o controle da qualidade, garantindo a segurança e eficácia do produto biotecnológico.
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Correlação entre a espessura da parede vesical e os achados urodinâmicos em pacientes com lesão medular traumática. Avaliação da influência das alterações morfológicas da bexiga nos resultados da injeção de toxina botulínica tipo-A no detrusor / Association between the bladder wall thickness and urodynamic findings in patients with spinal cord injury. Evaluation of the influence of the morphological changes of the bladder on the results of botulinum toxin type-A injection in the detrusorJosé Ailton Fernandes Silva 08 April 2013 (has links)
Medir a espessura da parede vesical (EPV) através da ultrassonografia, correlacioná-la com os parâmetros urodinâmicos e avaliar o papel destes parâmetros para lesão do trato urinário superior. Avaliar também o papel das alterações da forma da bexiga nos resultados de injeção de toxina botulínica tipo-A (BTX-A) no detrusor em pacientes com lesão medular traumática (LMT). Trata-se de dois estudos. O primeiro é um estudo transversal de 272 pacientes com LMT submetidos à ultrassonografia renal e de bexiga e estudo urodinâmico. A parede anterior da bexiga foi medida e comparada com os dados urodinâmicos. A cistografia foi realizada em 57 pacientes. O segundo foi um estudo prospectivo avaliando os resultados da injeção de BTX-A no detrusor em 27 pacientes considerando os achados urodinâmicos (pré e pós procedimento) e as deformidades da bexiga (cistografia). A média da EPV foi de 3,94 mm e foi estatisticamente maior em pacientes com hiperatividade detrusora neurogênica associada à dissinergia vesicoesfincteriana (HDN/DVE), em comparação com aqueles sem DVE (p<0,001). Essa média também foi maior em pacientes com complacência < 20 mL/cmH2O, comparada aos pacientes com complacência ≥ 20 mL/cmH2O (p<0,001). A média da pressão detrusora máxima (Pdet Max) foi estatisticamente maior nos pacientes com refluxo vesicoureteral (RVU) em comparação com aqueles sem RVU (100,7 vs 61,2 cmH2O respectivamente, p=0,022). Pacientes com complacência < 20 mL/cmH2O apresentaram prevalência de hidronefrose 4,2 vezes maior, comparada aos pacientes com complacência ≥ 20 mL/cmH2O. Não houve associação estatística entre EPV e hidronefrose ou RVU. Vinte e sete pacientes foram submetidos à injeção de BTX-A no detrusor. A média de tempo de continência urinária foi de 8 meses. Nove pacientes (33,3%) tinham forma vesical alterada e 8 casos (29,6%) tinham divertículos. A capacidade cistométrica máxima, Pdet max, volume reflexo e complacência não apresentaram diferença significativa na presença de divertículos ou alteração da forma. O aumento da EPV está associado à complacência < 20 mL/cmH2O e HDN/DVE em pacientes com LMT. No entanto, não houve relação entre a EPV e hidronefrose ou RVU. Baixa complacência e HDN/DVE são os principais fatores de risco para dano ao trato urinário superior. A presença de divertículos ou alteração da forma vesical não influenciou nos resultados após injeção de BTX-A no detrusor. / To investigate the ultrasonographic bladder wall thickness (BWT), urodynamic parameters and evaluate the role of such measurements for the upper and lower urinary tract deterioration and also assess the role of changes in bladder shape in the outcome of botulinum toxin type A (BTX-A) into the detrusor in patients with spinal cord injury (SCI). There are two studies. First study was a cross-sectional study involving two hundred and seventy two patients with SCI who underwent renal and bladder ultrasonography and urodynamic evaluation. The anterior bladder wall was measured and compared to urodynamic data. Cystography was done in 57 patients. The second was a prospective study about injection of BTX-A into the detrusor performed in 27 patients considering urodynamic parameters and cystography findings. Mean BWT was 3.94 mm. BWT was statistically higher in patients with neurogenic detrusor overactivity associated to detrusor sphincter dyssynergia (NDO/DSD) and in those with compliance < 20 mL/cmH2O. Patients with low compliance (< 20 mL/cmH2O), had 4.2 times higher prevalence of hydronephrosis, compared to patients with compliance ≥ 20 mL/cmH2O. Mean of Pdet max was statistically higher in patients with vesicoureteral reflux (VUR) compared to those without (100.7 vs 61.2 cmH2O respectively, p=0.022). There was no statistical association between BWT and hydronephrosis or VUR. Twenty seven patients underwent injection of BTX-A into the detrusor. The average time of urinary continence was 8 months. Nine patients (33.3%) had altered bladder shape and 8 cases (29.6%) had diverticula. The maximum cystometric capacity, NDO, reflex volume and compliance showed no statistically significant difference in the presence of diverticula or altered bladder shape. Increased BWT is associated with low compliance and NDO/DSD in patients with SCI. However, there was no relationship between BWT and hydronephrosis or VUR. Low compliance and NDO/DSD are the main risk factors for the upper urinary tract damage. The presence of diverticula or changes in bladder shape did not influence the results after injection of BTX-A into the detrusor.
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Mundgesundheitsstatus und Untersuchungen zur Auswirkung einer Botulinumtoxin-Injektionstherapie bei oromandibulären Dysfunktionen auf das stomatognathe System / Oral health status and studies on the effect of botulinum toxin injection therapy on oromandibular dysfunction on the stomatognathic systemZiebolz, Holger 28 October 2019 (has links)
No description available.
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Efekt prolongovaného strečinku na kontrakturu spastického svalu před a po aplikaci botulotoxinu - A / The effect of prolonged stretching on spastic muscle contracture before and after Botulinum toxin A applicationMiňová, Zuzana January 2021 (has links)
A large proportion of patients with central motoneuron lesions is at risk of spastic paresis and formation of contractures. One of the therapeutic techniques used in patients with spastic paresis is prolonged stretching. The theoretical part summarizes the knowledge regarding spastic paresis, its clinical evaluation, the development of contractures and therapeutic interventions, especially botulinum toxin (BTX) and stretching. The aim of this study was to compare the effectiveness of prolonged stretching on spastic muscle contracture before and after BTX application. In our retrospective comparative study there were included 30 patients divided into two groups. The first group consisted of 15 patients performing prolonged stretching of the m. rectus femoris (m. RF) for three months according to Guided Self-rehabilitation Contract of Professor J. M. Gracies. The second group (15 patients) performing the same procedure, but at the same time BTX was injected into the m. RF. We monitored the change in passive knee joint range of motion into flexion and the change in 10MWT time. Statistical evaluation showed that the difference in knee joint range of motion after three months of performing prolonged stretching was statistically insignificant (p=0.194). The difference in knee joint range of motion after...
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