A eficácia toxina botulínica combinada com a fisioterapia em crianças com paralisia cerebral espástica: uma revisão sistemática

Abstract

Introduction: Cerebral palsy (CP) is a spectrum of motor impairments resulting from non- progressive brain injury or malformation occurring in the early stages of development. Treatment of spasticity can be multimodal, including the use of botulinum toxin type A (BoNT- A), alone or in combination with physiotherapy techniques. Objective: To evaluate the effectiveness of BoNT-A associated with physiotherapy in the treatment of lower limb spasticity in children and adolescents with spastic CP. Methods: A search was conducted in the Medline, Embase, Web of Science, PEDro, and Scopus databases, in Portuguese and English, without date restriction, including only randomized controlled clinical trials. Study selection, data extraction, and methodological evaluation were conducted by two independent reviewers using the PEDro scale. Results: Eight studies were included. The most frequent physiotherapy interventions associated with BoNT-A were electrostimulation, serial casting, and rehabilitation programs with ankle-foot orthoses. The methodological quality of the studies ranged from low to moderate. There is evidence that the combination of BoNT-A with serial casting improves ankle range of motion in the short and long term. Rehabilitation programs using orthoses have also demonstrated functional benefits. However, the association with electrostimulation has shown limited evidence of effectiveness. Conclusion: The combination of BoNT-A with physiotherapy strategies, especially serial casting and orthosis use, shows promise in the treatment of spasticity in children and adolescents with spastic CP. However, the low methodological quality of the studies reinforces the need for more robust research to consolidate this evidence and guide clinical practices based on reliable data.