Douleurs et confort chez l'enfant en situation de handicap SOFMER / SFERHE 2

Le 16/10/2021 de 09:00 à 11:00

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TOXIMUS PC « Etude monocentrique transversale de l’effet anatomophysiologique de la toxine botulique sur le muscle spastique de l’enfant avec paralysie cérébrale »

Claire Mietton (Bron, France), Sandrine Mouradian (Lyon, France), Emmanuelle Girard (Lyon, France), Nathalie Streichenberger (Bron, France), Isabelle Poirot (Bron, France), Muriel Rabilloud (Lyon, France), Benjamin Riche (Lyon, France), Valérie Laudy (Bron, France), Myrtille Le Bouar (Bron, France)

Objectif : Botulinum toxin is one of the main available treatments to decrease spasticity related to cerebral palsy (CP). Its effectiveness was largely demonstrated. However, the long-term action of the toxin on the neuromuscular junction (NMJ) and muscle structure remains unknown in children with CP.
Our hypothesis is that botulinum toxin could have a long-term structural effect on muscle after multiple toxin injections. We propose here a prospective monocentric study to analyze structural long term modifications induced by toxin botulinium in terms of NMJ fragmentation and axonal sprouting.

Matériel/Patients et méthodes : Twenty third patients were enrolled on a three years period. Fifty-two muscular biopsies were performed in children with CP lower limbs during a planned surgery.  Seventeen biopsies were retained for the principal outcome (toxinated muscle and presence of NMJ on the sample).

Résultats : Results show that eighty-two percent of analyzed biopsies present abnormalities regarding NMJ fragmentation: moderated abnormality for ten biopsies (59%), and severe abnormality for four biopsies (24%). Expected axonal sprouting after repeated toxin injections was only observed in two biopsies (12%). Age, total dose of injected toxin, side of the inferior member injected and nature of injected product have no significant impact on the presence of NMJ fragmentation.

Discussion - Conclusion : This study give some first responses on the effects and security of long-term repeated botulinum toxin injections on children.

Mots clés : Toxin; Spastic neuromuscular junction; Cerebral palsy child