medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-0-113-121medsovet-1671Research ArticleДЕТСКАЯ НЕВРОЛОГИЯCHILD NEUROLOGYОПЫТ ПРИМЕНЕНИЯ ПРЕПАРАТА БОТУЛИНИЧЕСКОГО ТОКСИНА ТИПА А (OnabotulinumtoxinA*) В ЛЕЧЕНИИ ПАЦИЕНТОВ С ДЕТСКИМ ЦЕРЕБРАЛЬНЫМ ПАРАЛИЧОМEXPERIENCE OF THE TYPE A BOTULINUM TOXIN TYPE (ONABOTULINUMTOXINA) DRUG IN TREATMENT OF CEREBRAL PALSY PATIENTSКуренковА. Л.KurenkovA. L.

 д.м.н.

MD, 

КлочковаО. А.KlochkovaO. A.

к.м.н.

 

PhD in medicine

БурсаговаБ. И.BursagovaB. I.

к.м.н.

PhD in medicine

КузенковаЛ. М.KuzenkovaL. M.

д.м.н., профессор

MD, Prof.

АртеменкоА. Р.ArtemenkoA. R.

д.м.н.

MD

ФальковскийИ. В.FalkovskyI. V.Национальный научно-практический центр здоровья детей Минздрава России, МоскваРоссияScientific Center of Pediatric Health of the Ministry of Health of Russia, MoscowRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова Минздрава РоссииРоссияSechenov First Moscow Medical University of the Ministry of Health of RussiaRussian FederationООО «Нейроклиника», ХабаровскРоссияNeuroklinika LLC, KhabarovskRussian Federation20173012201701S113121Copyright © Куренков А.Л., Клочкова О.А., Бурсагова Б.И., Кузенкова Л.М., Артеменко А.Р., Фальковский И.В., 20172017Куренков А.Л., Клочкова О.А., Бурсагова Б.И., Кузенкова Л.М., Артеменко А.Р., Фальковский И.В.Kurenkov A.L., Klochkova O.A., Bursagova B.I., Kuzenkova L.M., Artemenko A.R., Falkovsky I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1671

При детском церебральном параличе (ДЦП) лечение инъекциями препаратов ботулинического токсина типа А (БТА) на сегодняшний день рассматривается как один из базовых методов. В статье подробно рассматриваются вопросы уникального механизма действия препаратов БТА, двойного сенсомоторного механизма действия препарата OnabotulinumtoxinA, невзаимозаменяемости препаратов БТА, доказательной базы эффективности и безопасности применения БТА при ДЦП, контроля точности инъекций БТА, выбора мышц-мишеней, оценки эффективности ботулинотерапии и др. К ботулинотерапии прибегают в тех случаях, когда проявления спастичности при ДЦП становятся значимыми и негативно влияют на функциональную активность и двигательное развитие ребенка. Инъекции препаратов БТА при ДЦП, как правило, применяют с 2-летнего возраста, и это лечение показано у 50–75% пациентов в зависимости от уровня двигательных возможностей по шкале GMFCS. Если при наличии показаний этот метод лечения не используется, то можно говорить о том, что лечение проводится не в полном объеме, и пациент лишается доказанно эффективного терапевтического подхода.

Injections of botulinum toxin type A (BTA) are regarded as one of the basic methods to treat cerebral palsy (CP). The article discusses issues unique mechanism of action of botulinum toxin type A injections, double sensomotor mechanism of action of the drug OnabotulinumtoxinA, noninterchangeability of BTA drugs, evidence of efficacy and safety of the use of BTA for children with cerebral palsy, accuracy control of BTA injections, selection of muscle targets, assess the effectiveness of botulinum toxin therapy, etc. To the therapy used in cases where the manifestations of spasticity in cerebral palsy become significant and negative influence on the functional activity and motor development of the child. Injections of botulinum toxin type A in cerebral palsy are usually applied from the age of 2 years, and this treatment is indicated for 50-75% of patients depending on the level of motor abilities by GMFCS scale. If this treatment is not used in presence of indications, it is possible to say that the treatment is carried out not in full and the patient is deprived of the proven effective therapeutic approach.

ботулинический токсин типа АOnabotulinumtoxinAдетский церебральный параличспастичностьшкала Эшворташкала Тардьешкала глобальных моторных функцийэквинусная установка стопымеханизм действия БТАневзаимозаменяемость препаратов БТАконтроль точности инъекций БТАоценка эффективности ботулинотерапииbotulinum toxin type AOnabotulinumtoxinApediatric cerebral palsyspasticityAshworth scaleTardieu scaleglobal motor function scaleequinus foot positionBTA mechanism of actionnoninterchangeability of botulinum toxin type A injectionsaccuracy control of BTA injectionsassessment of therapy effectivenessReferencesАзбука ботулинотерапии: научно-практическое издание (Кол. авт., под ред. С.Л. Тимербаевой). М.: Практическая медицина, 2014. 416 с.Азбука ботулинотерапии: научно-практическое издание (Кол. авт., под ред. С.Л. Тимербаевой). М.: Практическая медицина, 2014. 416 с.Heinen F, Desloovere K, Schroeder AS, Berweck S, Borggraefe I, van Campenhout A, Andersen GL, Aydin R, Becher JG, Bernert G, Caballero IM, Carr L, Valayer EC, Desiato MT, Fairhurst C, Filipetti P, Hassink RI, Hustedt U, Jozwiak M, Kocer SI, Kolanowski E, Krägeloh-Mann I, Kutlay S, Mäenpää H, Mall V, McArthur P, Morel E, Papavassiliou A, Pascual-Pascual I, Pedersen SA, Plasschaert FS, van der Ploeg I, Remy-Neris O, Renders A, Di Rosa G, Steinlin M, Tedroff K, Valls JV, Viehweger E, Molenaers G. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur. J. Paediatr. Neurol., 2010, 14(1): 45-66.Heinen F, Desloovere K, Schroeder AS, Berweck S, Borggraefe I, van Campenhout A, Andersen GL, Aydin R, Becher JG, Bernert G, Caballero IM, Carr L, Valayer EC, Desiato MT, Fairhurst C, Filipetti P, Hassink RI, Hustedt U, Jozwiak M, Kocer SI, Kolanowski E, Krägeloh-Mann I, Kutlay S, Mäenpää H, Mall V, McArthur P, Morel E, Papavassiliou A, Pascual-Pascual I, Pedersen SA, Plasschaert FS, van der Ploeg I, Remy-Neris O, Renders A, Di Rosa G, Steinlin M, Tedroff K, Valls JV, Viehweger E, Molenaers G. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur. J. Paediatr. Neurol., 2010, 14(1): 45-66.Simpson DM, Gracies JM, Graham HK, Miyasaki JM, Naumann M, Russman B, Simpson LL, So Y. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2008, 70(19): 1691-1698.Simpson DM, Gracies JM, Graham HK, Miyasaki JM, Naumann M, Russman B, Simpson LL, So Y. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2008, 70(19): 1691-1698.Heinen F, Molenaers G, Fairhurst C, Carr LJ, Desloovere K, Chaleat Valayer E, Morel E, Papavassiliou AS, Tedroff K, Ignacio Pascual-Pascual S, Bernert G, Berweck S, Di Rosa G, Kolanowski E, Krägeloh-Mann I. European consensus table 2006 on botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol, 2006 Sep-Nov, 10(5-6): 215-25.Heinen F, Molenaers G, Fairhurst C, Carr LJ, Desloovere K, Chaleat Valayer E, Morel E, Papavassiliou AS, Tedroff K, Ignacio Pascual-Pascual S, Bernert G, Berweck S, Di Rosa G, Kolanowski E, Krägeloh-Mann I. European consensus table 2006 on botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol, 2006 Sep-Nov, 10(5-6): 215-25.Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol, 2013, 55(10): 885-910.Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol, 2013, 55(10): 885-910.Dolly JO, O’Connell MA. Neurotherapeutics to inhibit exocytosis from sensory neurons for the control of chronic pain. Curr Opin Pharmacol, 2012, 12: 100-108.Dolly JO, O’Connell MA. Neurotherapeutics to inhibit exocytosis from sensory neurons for the control of chronic pain. Curr Opin Pharmacol, 2012, 12: 100-108.Bax M, Goldstein M, Rosenbaum P et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol, 2005, 47(8): 571-576.Bax M, Goldstein M, Rosenbaum P et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol, 2005, 47(8): 571-576.Parkinson KN, Dickinson HO, Arnaud C, Lyons A, Colver A, SPARCLE group. Pain in young people aged 13 to 17 years with cerebral palsy: cross-sectional, multicentre European study. Arch Dis Child, 2013, 98(6): 434-440.Parkinson KN, Dickinson HO, Arnaud C, Lyons A, Colver A, SPARCLE group. Pain in young people aged 13 to 17 years with cerebral palsy: cross-sectional, multicentre European study. Arch Dis Child, 2013, 98(6): 434-440.Penner M, Xie WY, Binepal N, Switzer L, Fehlings D. Characteristics of pain in children and youth with cerebral palsy. Pediatrics, 2013 Aug, 132(2): 407-413.Penner M, Xie WY, Binepal N, Switzer L, Fehlings D. Characteristics of pain in children and youth with cerebral palsy. Pediatrics, 2013 Aug, 132(2): 407-413.Alriksson-Schmidt A, Hägglund G. Pain in children and adolescents with cerebral palsy: a population-based registry study. Acta Paediatr, 2016, 105(6): 665-670.Alriksson-Schmidt A, Hägglund G. Pain in children and adolescents with cerebral palsy: a population-based registry study. Acta Paediatr, 2016, 105(6): 665-670.Dickinson HO, Parkinson KN, Ravens-Sieberer U, Schirripa G, Thyen U, Arnaud C, Beckung E, Fauconnier J, McManus V, Michelsen SI, Parkes J, Colver AF. Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross-sectional European study. Lancet, 2007, 369(9580): 2171-2178.Dickinson HO, Parkinson KN, Ravens-Sieberer U, Schirripa G, Thyen U, Arnaud C, Beckung E, Fauconnier J, McManus V, Michelsen SI, Parkes J, Colver AF. Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross-sectional European study. Lancet, 2007, 369(9580): 2171-2178.Palisano R, Rosenbaum P, 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(4): 214-223.Palisano R, Rosenbaum P, 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(4): 214-223.Palisano RJ. A collaborative model of service delivery for children with movement disorders: a framework for evidence-based decision making. Phys Ther, 2006, 86(9): 1295-305.Palisano RJ. A collaborative model of service delivery for children with movement disorders: a framework for evidence-based decision making. Phys Ther, 2006, 86(9): 1295-305.Hanna SE, Rosenbaum PL, Bartlett DJ et al. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol, 2009, 51(4): 295-302.Hanna SE, Rosenbaum PL, Bartlett DJ et al. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol, 2009, 51(4): 295-302.Eliasson AC, Krumlinde-Sundholm L, Rösblad B et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol, 2006, 48(7): 549-54.Eliasson AC, Krumlinde-Sundholm L, Rösblad B et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol, 2006, 48(7): 549-54.Hidecker MJ, Paneth N, Rosenbaum PL et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol, 2011, 53(8): 704-10.Hidecker MJ, Paneth N, Rosenbaum PL et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol, 2011, 53(8): 704-10.Delgado M, Hirtz D, Aisen M et al. Practice Parameter: Pharmacologic treatment of spas-ticity in children and adolescents with cerebral palsy (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 2010, 74(4): 336-343.Delgado M, Hirtz D, Aisen M et al. Practice Parameter: Pharmacologic treatment of spas-ticity in children and adolescents with cerebral palsy (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 2010, 74(4): 336-343.Артеменко А.Р., Куренков А.Л. Ботулинический токсин: вчера, сегодня, завтра. Нервно-мышечные болезни, 2013, 2: 6-18.Артеменко А.Р., Куренков А.Л. Ботулинический токсин: вчера, сегодня, завтра. Нервно-мышечные болезни, 2013, 2: 6-18.Dressler D. Clinical applications of botulinum toxin. Curr Opin Microbiol, 2012, 15(3): 325-36.Dressler D. Clinical applications of botulinum toxin. Curr Opin Microbiol, 2012, 15(3): 325-36.Burgen A, Dickens F, Zatman LJ. The action of botulinum toxin on the neuromusculat junction. J Phisiol, 1949, 109: 10-24.Burgen A, Dickens F, Zatman LJ. The action of botulinum toxin on the neuromusculat junction. J Phisiol, 1949, 109: 10-24.Grissom JR. Chemical denervation. In book: Electrodiagnostic medicine, 2nd edition (Eds. D Dumitru, MJ Zwarts, AA Amato). Philadelphia: Hanley & Belfus, Inc., 2002: 479-512.Grissom JR. Chemical denervation. In book: Electrodiagnostic medicine, 2nd edition (Eds. D Dumitru, MJ Zwarts, AA Amato). Philadelphia: Hanley & Belfus, Inc., 2002: 479-512.Куренков А.Л., Артеменко А.Р., Никитин С.С., Орлова О.Р. Современные представления о механизмах действия ботулинического токсина типа А. Врач, 2009, 7: 8-12.Куренков А.Л., Артеменко А.Р., Никитин С.С., Орлова О.Р. Современные представления о механизмах действия ботулинического токсина типа А. Врач, 2009, 7: 8-12.Dressler D, Saberi FA, Barbosa ER. Botulinum toxin: mechanisms of action. Arq Neuropsiquiatr, 2005, 63: 180-5.Dressler D, Saberi FA, Barbosa ER. Botulinum toxin: mechanisms of action. Arq Neuropsiquiatr, 2005, 63: 180-5.Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology, 2005, 26(5): 785-93.Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology, 2005, 26(5): 785-93.Durham PL, Cady R. Insights into the mechanism of onabotulinumtoxinA in chronic migraine. Headache, 2011, 51(10): 1573-7.Durham PL, Cady R. Insights into the mechanism of onabotulinumtoxinA in chronic migraine. Headache, 2011, 51(10): 1573-7.Gazerani P, Pedersen NS, Staahl C et al. Subcutaneous Botulinum toxin type A reduces capsaicin-induced trigeminal pain and vasomotor reactions in human skin. Pain, 2009, 141(1-2): 60-9.Gazerani P, Pedersen NS, Staahl C et al. Subcutaneous Botulinum toxin type A reduces capsaicin-induced trigeminal pain and vasomotor reactions in human skin. Pain, 2009, 141(1-2): 60-9.Brin М, James C, Maltman J. Botulinum toxin type A products are not interchangeable: a review of the evidence. Biologics: Targets and Therapy, 2014, 8: 227-241.Brin М, James C, Maltman J. Botulinum toxin type A products are not interchangeable: a review of the evidence. Biologics: Targets and Therapy, 2014, 8: 227-241.Mohindru A, Bulloch S, Kronfeld N, James C. Analysis of clinical and non-clinical, peer-reviewed published studies investigating the use of commercially available botulinum toxins: an online and offline literature review. Poster presented at: 2nd International Congress on Treatment of Dystonial, May 9-12 May, 2013, Hannover, Germany.Mohindru A, Bulloch S, Kronfeld N, James C. Analysis of clinical and non-clinical, peer-reviewed published studies investigating the use of commercially available botulinum toxins: an online and offline literature review. Poster presented at: 2nd International Congress on Treatment of Dystonial, May 9-12 May, 2013, Hannover, Germany.Артеменко А.Р., Куренков А.Л., Беломестов К.В. К вопросу об отсутствие взаимозаменяемости лекарственных препаратов ботулинического токсина типа А. Ремедиум, 2015, 2: 3-12.Артеменко А.Р., Куренков А.Л., Беломестов К.В. К вопросу об отсутствие взаимозаменяемости лекарственных препаратов ботулинического токсина типа А. Ремедиум, 2015, 2: 3-12.Koman LA, Mooney JF 3rd, Smith B. et al. Management of cerebral palsy with botulinum-A toxin: preliminary investigation. J Pediatr Orthop, 1993, 13(4): 489-95.Koman LA, Mooney JF 3rd, Smith B. et al. Management of cerebral palsy with botulinum-A toxin: preliminary investigation. J Pediatr Orthop, 1993, 13(4): 489-95.Sutherland DH, Kaufman KR, Wyatt MP et al. Double-blind study of botulinum toxin injections into the gastrocnemius muscle in patients with cerebral palsy. Gait and Posture, 1999, 10: 1-9.Sutherland DH, Kaufman KR, Wyatt MP et al. Double-blind study of botulinum toxin injections into the gastrocnemius muscle in patients with cerebral palsy. Gait and Posture, 1999, 10: 1-9.Koman LA, Mooney JF 3rd, Smith BP et al. Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spas-ticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. BOTOX Study Group. J Pediatr Orthop, 2000, 20(1): 108-15.Koman LA, Mooney JF 3rd, Smith BP et al. Botulinum toxin type A neuromuscular blockade in the treatment of lower extremity spas-ticity in cerebral palsy: a randomized, double-blind, placebo-controlled trial. BOTOX Study Group. J Pediatr Orthop, 2000, 20(1): 108-15.Love SC, Valentine JP, Blair EM et al. The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomized controlled trial. Eur J Neurol, 2001, 8(Suppl 5): 50-8.Love SC, Valentine JP, Blair EM et al. The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomized controlled trial. Eur J Neurol, 2001, 8(Suppl 5): 50-8.Калинина Л.В., Сологубов Е.Г., Дутикова Е.М., Лузинович В.М. Ботокс в комплексном лечении детских церебральных параличей. Журн. неврологии и психиатрии, 2000, 100(12): 60-63.Калинина Л.В., Сологубов Е.Г., Дутикова Е.М., Лузинович В.М. Ботокс в комплексном лечении детских церебральных параличей. Журн. неврологии и психиатрии, 2000, 100(12): 60-63.Куренков А.Л., Клочкова О.А., Бурсагова Б.И., Кузенкова Л.М., Мамедъяров А.М., Артеменко А.Р., Петрова С.А. Применение препарата ботулинического токсина типа А (Ботокс) в лечении детского церебрального паралича. Нервно-мышечные болезни, 2014, 3: 28-41.Куренков А.Л., Клочкова О.А., Бурсагова Б.И., Кузенкова Л.М., Мамедъяров А.М., Артеменко А.Р., Петрова С.А. Применение препарата ботулинического токсина типа А (Ботокс) в лечении детского церебрального паралича. Нервно-мышечные болезни, 2014, 3: 28-41.Инструкция по применению лекарственного препарата для лекарственного применения Ботокс 100 ЕД. Регистрационный номер: П №011936/01, 2015.Инструкция по применению лекарственного препарата для лекарственного применения Ботокс 100 ЕД. Регистрационный номер: П №011936/01, 2015.Pascual-Pascual SI, Pascual-Castroviejo I, Ruiz PJ. Treating spastic equinus foot from cerebral palsy with botulinum toxin type A: what factors influence the results?: an analysis of 189 consecutive cases. Am J Phys Med Rehabil, 2011, 90(7): 554-63.Pascual-Pascual SI, Pascual-Castroviejo I, Ruiz PJ. Treating spastic equinus foot from cerebral palsy with botulinum toxin type A: what factors influence the results?: an analysis of 189 consecutive cases. Am J Phys Med Rehabil, 2011, 90(7): 554-63.Дутикова Е.М., Кенис В.М., Куренков А.Л. Применение препарата Диспорт (ботулинический токсин типа А) для коррекции динамического эквинуса у детей с ДЦП// Разрешение на применение новой медицинской технологии ФС № 2010/173 от 17 мая 2010 г. Москва, 2010. 23 с.Дутикова Е.М., Кенис В.М., Куренков А.Л. Применение препарата Диспорт (ботулинический токсин типа А) для коррекции динамического эквинуса у детей с ДЦП// Разрешение на применение новой медицинской технологии ФС № 2010/173 от 17 мая 2010 г. Москва, 2010. 23 с.Hustedt U. Botulinumtoxin bei spastischen Bewegungsstörungen. Ultraschallgestutzte Technik und Anwendung. Marburg: KVM – Der Medizinverlag, 2011. 205 p.Hustedt U. Botulinumtoxin bei spastischen Bewegungsstörungen. Ultraschallgestutzte Technik und Anwendung. Marburg: KVM – Der Medizinverlag, 2011. 205 p.Van Campenhout A, Bar-On L, Desloovere K, Molenaers G. Role of motor end plate-targeted Botulinum toxin type A injections in children with cerebral palsyitle. Acta Orthop Belg, 2015, 81(2): 167-71.Van Campenhout A, Bar-On L, Desloovere K, Molenaers G. Role of motor end plate-targeted Botulinum toxin type A injections in children with cerebral palsyitle. Acta Orthop Belg, 2015, 81(2): 167-71.Van Campenhout A, Molenaers G. Localization of the motor endplate zone in human skeletal muscles of the lower limb: anatomical guidelines for injection with botulinum toxin. J Dev Med Child Neurol, 2011, 53: 108-19.Van Campenhout A, Molenaers G. Localization of the motor endplate zone in human skeletal muscles of the lower limb: anatomical guidelines for injection with botulinum toxin. J Dev Med Child Neurol, 2011, 53: 108-19.Van Campenhout A, Verhaegen A, Pans S, Molenaers G. Botulinum toxin type A injections in the psoas muscle of children with cerebral palsy: muscle atrophy after motor end plate-targeted injections. Res Dev Disabil, 2013, 34(3): 1052-1058.Van Campenhout A, Verhaegen A, Pans S, Molenaers G. Botulinum toxin type A injections in the psoas muscle of children with cerebral palsy: muscle atrophy after motor end plate-targeted injections. Res Dev Disabil, 2013, 34(3): 1052-1058.Schroeder A, Berweck S, Lee S, Heinen F. Botulinum toxin treatment of children with cerebral palsy — a short review of different injection techniques. Neurotox Res, 2006, 9(2-3): 189-196.Schroeder A, Berweck S, Lee S, Heinen F. Botulinum toxin treatment of children with cerebral palsy — a short review of different injection techniques. Neurotox Res, 2006, 9(2-3): 189-196.Alter K.E. High-frequency ultrasound guidance for neurotoxin injections. Phys. Med. Rehabil. Clin. N. Am., 2010, 21(3): 607-630.Alter K.E. High-frequency ultrasound guidance for neurotoxin injections. Phys. Med. Rehabil. Clin. N. Am., 2010, 21(3): 607-630.Клочкова О.А., Куренков А.Л., Мамедъяров А.М. и соавт. Контроль точности инъекций ботулинического токсина типа А при спастических формах детского церебрального паралича: выбор методики. Педиатрическая фармакология, 2013, 10(2): 80-86.Клочкова О.А., Куренков А.Л., Мамедъяров А.М. и соавт. Контроль точности инъекций ботулинического токсина типа А при спастических формах детского церебрального паралича: выбор методики. Педиатрическая фармакология, 2013, 10(2): 80-86.Berweck S, Heinen F. Use of botulinum toxin in pediatric spasticity (cerebral palsy). Mov. Disord. 2004, 19(Suppl 8): 162-167.Berweck S, Heinen F. Use of botulinum toxin in pediatric spasticity (cerebral palsy). Mov. Disord. 2004, 19(Suppl 8): 162-167.Py AG, Zein Addeen G, Perrier Y et al. Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance. Ann. Phys. Rehabil. Med., 2009, 52(3): 215-223.Py AG, Zein Addeen G, Perrier Y et al. Evaluation of the effectiveness of botulinum toxin injections in the lower limb muscles of children with cerebral palsy. Preliminary prospective study of the advantages of ultrasound guidance. Ann. Phys. Rehabil. Med., 2009, 52(3): 215-223.Kwon JY, Hwang JH, Kim JS. Botulinum toxin a injection into calf muscles for treatment of spastic equinus in cerebral palsy: a controlled trial comparing sonography and electric stimulation-guided injection techniques: a preliminary report. Am. J. Phys. Med. Rehabil., 2010, 89(4): 279-286.Kwon JY, Hwang JH, Kim JS. Botulinum toxin a injection into calf muscles for treatment of spastic equinus in cerebral palsy: a controlled trial comparing sonography and electric stimulation-guided injection techniques: a preliminary report. Am. J. Phys. Med. Rehabil., 2010, 89(4): 279-286.

The authors declare that there are no conflicts of interest present.