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psychoneuro 2008; 34(1): 24-28
DOI: 10.1055/s-2008-1061490
Schwerpunkt

© Georg Thieme Verlag Stuttgart · New York

Zerebralparese - Klassifikation und Therapie

Cerebral palsy - Classification and therapyUrban M. Fietzek1 , Steffen Berweck2
  • 1Abt. Neurologie und klinische Neurophysiologie, Neurologisches Krankenhaus München(Ärztliche Leitung: Prof. Dr. A. Ceballos-Baumann)
  • 2Abt. für Pädiatrische Neurologie und Entwicklungsneurologie, Dr. von Haunersches Kinderspital der Universität München(Leiter: Prof. Dr. F. Heinen)
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Publication History

Publication Date:
27 February 2008 (online)

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Zerebralparesen sind die häufigste Ursache einer spastischen Bewegungsstörung im Kindesalter. Der Artikel stellt aktuelle pathophysiologische Konzepte zur Zerebralparese dar und gibt einen Überblick über die interdisziplinären Behandlungsmöglichkeiten der motorischen Störung. Insbesondere wird auf die funktionellen Therapien und die Behandlung mit Botulinumtoxin eingegangen.

Cerebral palsy is the most common etiology of a spastic movement disorder in childhood. The present paper gives an introduction to the classification, the phenomenology, the diagnosis and current pathophysiological concepts of the cerebral palsies. It focusses on the interdisciplinary therapy approach of the motor disorder, especially on the functional therapies and the treatment with botulinum toxin.

Key words

Cerebral palsy - spastic - dyskinetic - botulinum toxin - physical therapy - orthotic devices

Literatur

  • 1 Ackman JD, Russman BS, Thomas SS. et al. . Comparing botulinum toxin A with casting for treatment of dynamic equinus in children with cerebral palsy.  Dev Med Child Neurol. 2005;  47 620-627
    CrossrefPubMedGoogle Scholar
  • 2 Albright AL.. Intrathecal baclofen in cerebral palsy movement disorders.  J Child Neurol. 1996;  11 29-35
    PubMedGoogle Scholar
  • 3 Andersson C, Grooten W, Hellsten M. et al. . Adults with cerebral palsy: walking ability after progressive strength training.  Dev Med Child Neurol. 2003;  45 220-228
    CrossrefPubMedGoogle Scholar
  • 4 Ashwal S, Russman BS, Blasco PA. et al. . Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.  Neurology. 2004;  62 851-863
    CrossrefPubMedGoogle Scholar
  • 5 Baker R, Jasinski M, Maciag-Tymecka I. et al. . Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study.  Dev Med Child Neurol. 2002;  44 666-675
    CrossrefPubMedGoogle Scholar
  • 6 Barwood S, Baillieu C, Boyd R. et al. . Analgesic effects of botulinum toxin A: a randomized, placebo-controlled clinical trial.  Dev Med Child Neurol. 2000;  42 116-121
    CrossrefPubMedGoogle Scholar
  • 7 Berweck S, Feldkamp A, Francke A. et al. . Sonography-guided injection of botulinum toxin A in children with cerebral palsy.  Neuropediatrics. 2002;  33 221-223
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Berweck S, Schroeder AS, Fietzek UM, Heinen F.. Sonography-guided injection of botulinum toxin in children with cerebral palsy.  Lancet. 2004;  363 249-250
    PubMedGoogle Scholar
  • 9 Blundell SW, Shepherd RB, Dean CM. et al. . Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years.  Clin Rehabil. 2003;  17 48-57
    CrossrefPubMedGoogle Scholar
  • 10 Bodkin AW, Baxter RS, Heriza CB.. Treadmill training for an infant born preterm with a grade III intraventricular hemorrhage.  Phys Ther. 2003;  83 1107-1118
    PubMedGoogle Scholar
  • 11 Campbell WM, Ferrel A, McLaughlin JF. et al. . Long-term safety and efficacy of continuous intrathecal baclofen.  Dev Med Child Neurol. 2002;  44 660-665
    CrossrefPubMedGoogle Scholar
  • 12 Corry IS, Cosgrove AP, Duffy CM. et al. . Botulinum toxin A compared with stretching casts in the treatment of spastic equinus: a randomised prospective trial.  J Pediatr Orthop. 1998;  18 304-311
    CrossrefPubMedGoogle Scholar
  • 13 Corry IS, Cosgrove AP, Walsh EG. et al. . Botulinum toxin A in the hemiplegic upper limb: a double-blind trial.  Dev Med Child Neurol. 1997;  39 185-193
    CrossrefPubMedGoogle Scholar
  • 14 Cosgrove AP, Graham HK.. Botulinum toxin A prevents the development of contractures in the hereditary spastic mouse.  Dev Med Child Neurol. 1994;  36 379-385
    PubMedGoogle Scholar
  • 15 Crothers B, Paine RS.. Natural History of Cerebral Palsy. Cambridge: Harvard University Press 1959
    Google Scholar
  • 16 Damiano DL.. Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy.  Phys Ther. 2006;  86 1534-1540
    CrossrefPubMedGoogle Scholar
  • 17 Dodd KJ, Foley S.. Partial body-weight-supported treadmill training can improve walking in children with cerebral palsy: a clinical controlled trial.  Dev Med Child Neurol. 2007;  49 101-105
    CrossrefPubMedGoogle Scholar
  • 18 Dodd KJ, Taylor NF, Graham HK.. A randomized clinical trial of strength training in young people with cerebral palsy.  Dev Med Child Neurol. 2003;  45 652-657
    CrossrefPubMedGoogle Scholar
  • 19 Elbert T, Rockstroh B, Bulach D. et al. . Die Fortentwicklung der Neurorehabilitation auf verhaltensneurowissenschaftlicher Grundlage. Beispiel Constraint-induced-Therapie.  Nervenarzt. 2003;  74 334-342
    CrossrefPubMedGoogle Scholar
  • 20 Eliasson AC, Krumlinde-Sundholm L, Shaw K, Wang C.. Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model.  Dev Med Child Neurol. 2005;  47 266-275
    CrossrefPubMedGoogle Scholar
  • 21 Eyre JA, Miller S, Ramesh V.. Constancy of central conduction delays during development in man: investigation of motor and somatosensory pathways.  J Physiology. 1991;  434 441-452
    PubMedGoogle Scholar
  • 22 Fehlings D, Rang M, Glazier J, Steele C.. An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy.  J Pediatr. 2000;  137 331-337
    CrossrefPubMedGoogle Scholar
  • 23 Flett PJ, Stern LM, Waddy H. et al. . Botulinum toxin A versus fixed cast stretching for dynamic calf tightness in cerebral palsy.  J Paediatr Child Health. 1999;  35 71-77
    CrossrefPubMedGoogle Scholar
  • 24 Fuchs A, Doderlein L.. Orthopädietechnik und ICP: Aktuelle Versorgungen und Trends in der Orthopädietechnik bei Patienten mit infantiler Zerebralparese.  Orthopade. 2004;  33 1173-1182
    CrossrefPubMedGoogle Scholar
  • 25 Heinen F, Molenaers G, Fairhurst. et al. . European consensus table 2006 on botulinum toxin for children with cerebral palsy.  Eur J Paediatr Neurol. 2006;  10 215-225
    CrossrefPubMedGoogle Scholar
  • 26 Jongerius PH, Rotteveel JJ, van Limbeek J. et al. . Botulinum toxin effect on salivary flow rate in children with cerebral palsy.  Neurology. 2004;  63 1371-1375
    PubMedGoogle Scholar
  • 27 Koman LA, Mooney JF, Smith BP. et al. . Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spasticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. BOTOX Study Group.  J Pediatr Orthop. 2000;  20 108-115
    CrossrefPubMedGoogle Scholar
  • 28 Little WJ.. On the influence of abnormal parturition, difficult labours, premature birth, and asphyxia neonatorum, on the mental and physical condtion of the child, especially in relation to deformities. (Originally published 1862).  Cerebral Palsy Bulletin. 1958;  1 5-36
    PubMedGoogle Scholar
  • 29 Lowe K, Novak I, Cusick A.. Low-dose/high-concentration localized botulinum toxin A improves upper limb movement and function in children with hemiplegic cerebral palsy.  Dev Med Child Neurol. 2006;  48 170-175
    CrossrefPubMedGoogle Scholar
  • 30 Mahrhold S, Rummel A, Bigalke H. et al. . The synaptic vesicle protein 2C mediates the uptake of botulinum neurotoxin A into phrenic nerves.  FEBS Lett. 2006;  580 2011-2014
    CrossrefPubMedGoogle Scholar
  • 31 Mall V, Heinen F, Siebel A. et al. . Treatment of adductor spasticity with BTX-A in children with CP: a randomized, double-blind, placebo-controlled study.  Dev Med Child Neurol. 2006;  48 10-13
    PubMedGoogle Scholar
  • 32 McNevin NH, Coraci L, Schafer J.. Gait in adolescent cerebral palsy: the effect of partial unweighting.  Arch Phys Med Rehabil. 2000;  81 525-528
    CrossrefPubMedGoogle Scholar
  • 33 Morris C.. A review of the efficacy of lower-limb orthoses used for cerebral palsy.  Dev Med Child Neurol. 2002;  44 205-211
    CrossrefPubMedGoogle Scholar
  • 34 de Paiva A, Meunier FA, Molgó J. et al. . Functional repair of motor endplates after botulinum neurotoxin type A poisoning: biphasic switch of synaptic activity between nerve sprouts and their parent terminals.  Proc Natl Acad Sci U S A. 1999;  96 3200-3205
    CrossrefPubMedGoogle Scholar
  • 35 Palisano R, Rosenbaum PL, Walter S. et al. . Development and reliability of a system to classify gross motor function in children with cerebral palsy.  Dev Med Child Neurol. 1997;  39 214-223
    CrossrefPubMedGoogle Scholar
  • 36 Paneth N.. The causes of cerebral palsy. Recent evidence.  Clin Invest Med. 1993;  16 95-102
    PubMedGoogle Scholar
  • 37 Penn RD, Kroin JS.. Continuous intrathecal baclofen for severe spasticity.  Lancet. 1985;  2 125-127
    PubMedGoogle Scholar
  • 38 Petruch U, Weber PM, Krageloh-Mann I. The reference and training manual of the SCPE (Surveillance of Cerebral Palsy in Europe).  Neuropediatrics. 2004;  35
    PubMedGoogle Scholar
  • 39 Polak F, Morton R, Ward C. et al. . Double-blind comparison study of two doses of botulinum toxin A injected into calf muscles in children with hemiplegic cerebral palsy.  Dev Med Child Neurol.. 2002;  44 551-555
    CrossrefPubMedGoogle Scholar
  • 40 Reddihough DS, King JA, Coleman GJ. et al. . Functional outcome of botulinum toxin A injections to the lower limbs in cerebral palsy.  Dev Med Child Neurol. 2002;  44 820-827
    CrossrefPubMedGoogle Scholar
  • 41 Reime U, Riedel M.. Wirksamkeit dynamischer Sprunggelenk (DAFO) und Fussorthesen (DFO) nach Hylton auf die grobmotorische Funktion zerebral bewegungsgestörter Kinder.  Orthop Prax. 2000;  36 622-628
    PubMedGoogle Scholar
  • 42 Rosales RL, Bigalke H, Dressler D.. Pharmacology of botulinum toxin: differences between type A preparations.  Eur J Neurol. 2006;  13 2-10
    PubMedGoogle Scholar
  • 43 Rosenbaum PL, Walter SD, Hanna SE. et al. . Prognosis for gross motor function in cerebral palsy: creation of motor development curves.  JAMA. 2002;  288 1357-1363
    CrossrefPubMedGoogle Scholar
  • 44 Schindl MR, Forstner C, Kern H, Hesse S.. Treadmill training with partial body weight support in nonambulatory patients with cerebral palsy.  Arch Phys Med Rehabil. 2000;  81 301-306
    CrossrefPubMedGoogle Scholar
  • 45 SCPE. . Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE).  Dev Med Child Neurol. 2000;  42 816-824
    PubMedGoogle Scholar
  • 46 Speth LA, Leffers P, Janssen-Potten YJ, Vles JS.. Botulinum toxin A and upper limb functional skills in hemiparetic cerebral palsy: a randomized trial in children receiving intensive therapy.  Dev Med Child Neurol. 2005;  47 468-473
    CrossrefPubMedGoogle Scholar
  • 47 Stanley FJ.. Survival and cerebral palsy in low birthweight infants: implications for perinatal care.  Paediatr Perinat Epidemiol. 1992;  6 298-310
    PubMedGoogle Scholar
  • 48 Sutherland DH, Kaufman KR, Wyatt MP. et al. . Double-blind study of botulinum A toxin injections into the gastrocnemius muscle in patients with cerebral palsy.  Gait Posture. 1999;  10 1-9
    CrossrefPubMedGoogle Scholar
  • 49 Taub E, Ramey SL, DeLuca S, Echols K.. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment.  Pediatrics. 2004;  113 305-312
    CrossrefPubMedGoogle Scholar
  • 50 Taylor NF, Dodd KJ, Damiano DL.. Progressive resistance exercise in physical therapy: a summary of systematic reviews.  Phys Ther. 2005;  85 1208-1223
    PubMedGoogle Scholar
  • 51 Ubhi T, Bhakta BB, Ives HL. et al. . Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy.  Arch Dis Child. 2000;  83 481-487
    CrossrefPubMedGoogle Scholar
  • 52 Ziv I, Blackburn N, Rang M, Koreska J.. Muscle growth in normal and spastic mice.  Dev Med Child Neurol. 1984;  26 94-99
    PubMedGoogle Scholar
  • 53 Zuniga RE, Schlicht CR, Abram SE.. Intrathecal baclofen is analgesic in patients with chronic pain.  Anesthesiology. 2000;  92 876-880
    CrossrefPubMedGoogle Scholar
  • 54 Zupan V, Gonzalez P, Lacaze-Masmonteil T. et al. . Periventricular leukomalacia: risk factors revisited.  Dev Med Child Neurol. 1996;  38 1061-1067
    PubMedGoogle Scholar

Korrespondenz

Dr. med. Urban M. Fietzek

Neurologisches Krankenhaus München

Parzivalplatz 4

80804 München

Email: urban.fietzek@nk-m.de

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