RESUMEN
OBJECTIVE: To assess the efficacy of botulinum toxin A injection for the management of spastic calf muscles in children with cerebral palsy. DATA SOURCES: We reviewed all relevant literature indexed in MEDLINE, CINAHL, EMBASE, PEDro and the Cochrane Registered Trials, and also hand reviewed abstracts. METHODS: Eligible studies were randomized controlled trials that compared botulinum toxin A injection with any type of treatment or no treatment with identical conditions. We extracted data on calf muscle tone, passive ankle range of motion, gait speed, ankle kinematics and Gross Motor Function Measure, and assessed methodological qualities. RESULTS: Fifteen studies met our inclusion criteria. When botulinum injection was compared with a non-sham control, it was found to be effective at improving calf muscle tone (one month: -2.73 (confidence interval (CI) -3.42 to -2.04), three months: -1.72 (-2.68 to -0.76)), passive ankle range of motion (one month: 3.29 (CI 2.52 to 4.05), three months: 1.00 (CI 0.44 to 1.56)) and gait speed (one month: 0.91 (CI 0.29 to 1.53), three months: 0.61 (CI 0.01 to 1.21)) for four months, as well as Gross Motor Function Measure (2.02 (CI 1.30 to 2.75)) for two months. When compared with sham injection, botulinum injection was only effective on Gross Motor Function Measure (0.98 (CI 0.28 to 1.69)) after four months. CONCLUSIONS: Although we found evidence supporting the efficacy of botulinum toxin A in studies comparing botulinum injection with non-sham controls, we did not find clear evidence of support in studies comparing botulinum injection with sham injection.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Parálisis Cerebral/complicaciones , Espasticidad Muscular/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Niño , Humanos , Pierna , Espasticidad Muscular/etiología , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/fisiopatología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
As an important cellular component of the innate immune system, NK cells constitute a first line of defense against various infections and malignancies. Previous studies have reported electroacupuncture (EA) modulation of natural killer cell (NK cell) activities. Our study confirmed that EA treatment increases NK cell activity using (51)Cr release assay. Furthermore, in order to better understand the activation mechanism of NK cell by EA, we employed a cDNA microarray technique to elucidate how EA alters gene expressions in the spleen of rats. We screened EA responsive genes using a high-throughput screening and identified 154 genes. Among those genes we selected 4 genes that are known to play a crucial role in NK cell activation and examined their mRNA expressions after EA treatment using RT-PCR. Our data shows that EA treatment increased CD94, PTK and VCAM-1 expressions while decreased PTP and SHP-1. These results imply that EA treatment increase PTK expression, which increases NK cell activity, through induction of CD94 while decreases SHP-1, which inhibits NK cell activity, simultaneously so that it activates NK cell with high efficacy. It seems that increased VCAM-1 expression is due to INF-gamma produced by activated NK cell. Increased production of VCAM-1 is expected to play an important role in binding of NK cell to the target cell. The result of our study may provide key insights in understanding the mechanisms of activation of NK cell induced by EA.