If both the child and another person assessment had been performed, then, we used the VAS scale of the child in our analysis. The reliability and validity of the Face, Legs, Activity, Cry. When there were several injections during a session, evaluation pertained to the most painful moment.
The variables were expressed in means with standard deviations for the quantitative values and in percentages for the qualitative values. As the distributions of the quantitative variables were not always Gaussian, we also calculated the median, the minimum and maximum values and the confidence interval. If the P value was less than 0. SAS 9. One hundred and fifty-five sessions of intramuscular botulinum toxin injection took place from May to October The 40 injection sessions involving the upper limbs were eliminated from consideration, as were 5 sessions with patients more than 18 years of age, 2 in which the data were insufficient, and 1 because localization had been exclusively anatomical.
The remaining sessions were analyzed. Average age of the children was An average of 5. Forty-three percent of the subjects were girls. The groups in which localization was obtained by either ultrasound or electrostimulation did not significantly differ in terms of age, number of injection sites, average duration of injection, volume injected or pre-analgesic techniques applied. As regards hydroxyzine and paracetamol, frequency of use was too low to carry out statistical analysis.
As shown in Fig. The VAS average was significantly higher in the electrostimulation group than in the ultrasound group: 4. The average FLACC score was significantly higher in the electrostimulation group than in the ultrasound group: 3. Our findings show that whether pain is measured by self-evaluation or by hetero-evaluation, it is significantly lower when toxin injections are carried out using ultrasound localization.
To our knowledge, this is the first study to assess the role of the localization technique chosen with regard to perception of the pain induced by botulinum toxin injections in children. During muscle localization procedures, the pain provoked by electrostimulation is well known and has been observed by all the physicians having applied the technique.
However, it was hardly obvious that lessened pain during the localization phase would lead to a significant decrease in perception of pain with regard to the injection taken as a whole.
In fact, the overall procedure of intramuscular botulinum toxin injection involves numerous additional algesic elements, such as the puncture, product injection itself, and the anxiety engendered by the hospital environment.
In this respect, recent studies by Brochard et al. And yet, our study demonstrates that a less painful localization technique, in this case ultrasound, indeed affects the child's perception of pain with regard to the procedure taken as a whole. As regards quantitative pain assessment during the sessions organized for our sample, the VAS average came to 3.
Click here to see the Library ], and they are close to those already reported, particularly by Brochard et al. The study by Brochard et al. These results show that pain treatment with present-day protocols is still insufficient, and they underline the interest of ongoing attempts to develop a less painful technique.
During each session, an average of 5. On the other hand, in our study, the number of injection sites is lower 5. At times, ultrasound localization allows for injection of several muscles at a single injection site. For example, the soleus muscle and the underlying gastrocnemius muscle can receive one injection at a single site by inserting a needle more deeply and through visualization of the perimysium separating the two muscles.
Our results craigslist asheville nc rideshare not include comparative evaluation of procedure effectiveness according to the localization technique applied; that was not the objective of our study. Use of ultrasound obviously necessitates an available ultrasound apparatus, which is expensive and requires a sizable investment when centers do not possess the device.
The main limit of this study is the lack of randomization, which would have enabled us to distribute the patients between the two groups according to the localization technique applied. In point of fact, a localization technique was chosen by the injecting physician according to the availability of an ultrasound apparatus. Another methodological limit consisted of the impossibility of blinded evaluation.
Indeed, our localization technique can hardly be hidden from the patient or the caretaker assessing the pain felt by the child during the procedure. Moreover, our study was not designed to evaluate comparative effectiveness from the standpoint of the efficacy of a procedure according to the localization technique applied.
Complementary studies are necessary. In our study, localization using electrostimulation intensified the pain provoked by injections of botulinum toxin in our group of children. Ultrasound is an interesting technique that could help to diminish the pain experienced during the localization phase and might lead to decreased perception of pain throughout the session.
L'hégémonie du Botox menacée par de nouveaux concurrents
Complementary studies in adult populations would be useful, and they could help to compare the effectiveness of therapeutic procedures according to the localization technique applied. Were ultrasound apparatuses to become less expensive to acquire, and were more PRM physicians to be trained, use of the technique could grow more widespread.
The authors declare that they have no conflicts of interest concerning this article. Malheureusement la réalisation de ces injections intramusculaires est parfois douloureuse rendant ce geste difficile chez les enfants. Il existe plusieurs techniques de repérage à notre disposition.
Depuis quelques années, le repérage par échographie se développe. Des études récentes montrent son intérêt dans les injections intramusculaires pour le traitement de la spasticité chez les enfants. Sur le verso de la réglette, la cotation se fait de 0 à injection botox essonne karaté Les variables ont été exprimées en moyennes avec écarts-types pour les valeurs quantitatives et en pourcentages pour les valeurs qualitatives.
La valeur de p est considérée comme significative si inférieure à 0, Le logiciel SAS version 9. Les 40 séances où les injections avaient été effectuées au niveau des membres supérieurs ont été exclues, 5 séances ont été exclues car concernant des patients âgés de plus de 18 ans, 2 pour données insuffisantes, et 1 car le repérage avait été effectué anatomiquement uniquement.
Au total, séances ont été analysées. Les différentes caractéristiques des patients sont décrites dans le Tableau 1. Ainsi, les études récentes de Brochard et al. Ces résultats sont proches des valeurs précédemment publiées notamment par Brochardet al. Ces résultats montrent que la prise en charge de la douleur par les protocoles actuels est donc encore insuffisante et justifie la poursuite de recherche de technique moins douloureuse.
Des études complémentaires sont nécessaires. Français Español Italiano. Previous Article Does galvanic vestibular stimulation reduce spatial neglect? A negative study A. Ruet, C. Jokic, P. Denise, F. Leroy, P. Journal page Archives Sommaire. Allard, G.
Traduction de "Dysport" en anglais
Botulinum toxin has a promising future in urology but requires further scientific evaluation. Revue systématique de la littérature à partir de la banque de données PubMed. Dix-neuf études ont été retenues dont trois essais randomisés.
Les effets secondaires sont rares, dominés par le risque de rétention urinaire qui semble corrélé à la dose utilisée. The condition manifests itself as an overactive bladder syndrome. The sometimes major sociopsychological impact of this condition justifies appropriate therapeutic management. The prevalence of bladder overactivity varies with age and gender. Its incidence increases with age and is respectively The use of botulinum toxin A in children with a non neurogenic overactive bladder.
Anticholinergic drugs represent the first-line treatment for bladder overactivity. This therapy is usually effective but often produces troublesome side effects which may prompt patients to stop taking their medication.
The following keywords were used: botulinum toxin, detrusor overactivity, non-neurogenic, refractory, urodynamic status. Botulinum toxin is a neurotoxin produced by the sporulating, anaerobic, Gram-negative bacterium Clostridium effekt af botoxwhich is widely distributed in the environment soil, dust, etc.
In the s, Dyskra et al. Botulinum toxin was subsequently used by Schurch in in the treatment of detrusor overactivity in spine-injured patients. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? In striated muscle, botulinum toxin has endopeptidase activity in the cytoplasm of peripheral nerve endings. The internalized neurotoxin is cleaved into two protein chains which deactivate the soluble N-ethylmaleimide-sensitive factor attachment receptor SNARE family proteins required for exocytosis of synaptic vesicles at the nerve ending.
A number of authors have demonstrated that botulinum toxin also inhibits the urothelial and suburothelial release of various mediators acetylcholine, ATP, substance P, glutamate, etc. This suggests an effect on both the efferent part of the voiding reflex and regulation of the afferent message. Modified expression of certain receptors has also been reported by Apostolidis et al. Intradetrusor injections of botulinum toxin are performed on an outpatient basis or during day hospitalization.
The urine must be germ-free. Prophylaxis with antibiotics is not always justified. Injections are made craigslist asheville nc rideshare between 20 and 30 detrusor sites depending on the research protocol in question and outside the trigonal region, in most cases ; this corresponds to four to six sites in the posterior, upper and left and right faces, respectively.
The injections are performed in the upper part of the detrusor muscle. It is not medically justified to leave an indwelling catheter in the bladder. The procedure usually takes around 20 minutes. By analogy with other indications in striated muscle, intramuscular injections were performed initially. Will suburothelial injection of small dose of botulinum toxin have similar therapeutic effects and less adverse events on refractory detrusor overactivity?
Its effect persists for between six and nine months, depending on the study in question. In the absence of specific studies, the reinjection criteria and frequency remain to be established. On the whole, two strategies can be used: reinjection before the recurrence of symptoms or following the reappearance of urine leakage or urgency.
Table 1 summarizes the various studies on the efficacy of botulinum toxin in the symptomatic treatment of NNDO. In all, 19 studies have been performed. Only three of these were randomized; the remainder were open-label studies. The primary inclusion criterion in these studies generally corresponded to second-line treatment for refractory or intolerably troublesome bladder overactivity or contraindication of anticholinergic drugs.
The criteria used to evaluate the efficacy of botulinum toxin in this situation vary considerably from one group to another. This latter method of leakage quantification must, however, be used with caution, since it has not been validated for urge incontinence.
Urodynamic parameters are also used to evaluate the effect of the toxin on bladder function, both in terms of efficacy and safety of use risk of retention. Other urodynamic parameters such as the maximum urinary flow rate and bladder contractility are monitored to detect possible complications of treatment with botulinum toxin.
InSchmid et al. The dose injected avoiding the trigone was U. The absence of clinical and urodynamic improvement was noted in eight patients who initially had compliance disorders. This study had the advantage of being prospective and investigated a large number of patients. Sahai is one of the few authors to have performed a randomized, placebo-controlled study.
Botulinum toxin injection into the detrusor: an effective treatment in idiopathic and neurogenic detrusor overactivity? The results were judged to be excellent i. Five patients felt better after treatment.
However, the improvement in urodynamic parameters seen three and six months after treatment was not always statistically significant. In this study, the use of a rigid fibre-optic endoscope prevented injection into the anterior bladder wall leading to heterogeneous distribution of the toxin within the detrusor and may thus have biased the study results.
Efficacy of botulinum toxin A in the treatment of detrusor overactivity incontinence. The urodynamic data reported by Schmid et al. The treatment remained effective for five to nine months Table 2.
Is the bladder a reliable witness for predicting detrusor overactivity? However, the performance of a urodynamic status check before and after treatment can be justified when seeking to identify patients who are not likely to respond to botulinum toxin treatment or those likely to present side effects and thus require close monitoring.
mtm rides yeux Large-scale, long-term clinical and urodynamic follow-up could help better identify factors that are predictive of the success or failure of botulinum toxin treatment.
In fact, in the absence of a comparative study of patients with or without detrusor overactivity, it is not possible to tell whether this latter factor is predictive of success or failure.
Overactivity syndrome can lead to depression, sexual disorders, sleep disorders and absenteeism from work. Hence, it can have a clearly negative impact on quality of life. Kalsi et al. The results were compared with cystometric and voiding diary data. This effect lasted for nine months and then declined.
Grosse et al. No other authors have reported this complication with the doses used in non-neurological patients.
A risk of bladder hypocontractility and thus urine retention and the need for self-catheterization has also been reported in the literature [2,18,22,28,33,39]. Sahai et al. Furthermore, the patient inclusion and exclusion criteria in the various studies may also give rise to bias and prevent intertrial comparisons. The studies also differed in terms of the injection sites and the equipment used.
Lastly, the toxin dose and dilution also varied from one study to another.