One-sided cerebral palsy, also known as stroke (hemiplegia), means that brain cells are damaged as a result of an obstruction or bleeding in the vessels leading to the brain, and as a result, the patient completely or partially loses the ability to move on one side of his body. Cerebral strokes are one of the most important causes of disability in our country.
In unilateral strokes, speech impairment, difficulty in swallowing, and paralysis of facial muscles may also occur. After the acute period, whether due to bleeding or obstruction, is over, the patient gradually begins to regain movements on that side. The first movements that appear are in a gross and Ilker pattern, that is, the patient cannot make fine movements. The emergence of these movements after cerebral palsy is related to brain plasticity. In other words, the function of the dying cells of the brain is fulfilled, at least partially, by cells that remain intact but whose main function is different. In this way, if the brain damage is mild, the patient can fully recover. In severely damaged brain strokes, more or less sequelae remain. In the process of recovery of movements after a stroke, recovery in the leg is almost always better than in the arm and hand. The most important event that occurs at this time and negatively affects the rehabilitation process is what we call spasticity, which is the excessive contraction of the paralyzed side muscles, preventing the emergence of new movements. This contraction occurs in one direction. For example, the patient's hand contracts to make a fist, and this prevents movement in the muscles that open the hand. This contraction is sometimes so severe that the patient's hand cannot be opened even with the help of an outside person. There are not many treatment alternatives in the fight against spasticity. Although medications are generally the first choice, side effects occur when doses are increased to provide adequate muscle relaxation, and therefore their effects remain limited. Spasticity can be reduced by damaging the nerves with chemical substances that were used more frequently in the past and are not preferred anymore. This method is used limitedly due to possible side effects. Physical therapy methods can only temporarily reduce spasticity. Our most important weapon in the fight against spasticity is botulinum toxin (botox) injection treatment. This toxin, which is actually produced by a microbe and later produced synthetically, is a very powerful muscle relaxant. is. Botulinum toxin causes temporary paralysis in the muscle where it is administered, lasting 3-4 months with varying severity depending on the dose. Botox is injected into overly tense muscles so that the patient can perform movements that he or she cannot usually do in one direction due to spasticity. Many muscles can be injected at one time. But the total dose should not exceed 400 IU. There are no significant side effects at these doses and it is an extremely reliable treatment. In this way, the muscles to which Botox is applied relax and a window period is created for movement to occur in other muscles during the recovery period of the paralysis. The effect of Botox lasts for 3-4 months. During this period, applying intensive physiotherapy to the patient strengthens the weak muscles, and when the effect of the drug wears off, these muscles become able to move. Depending on the patient's condition, botox injections can be continued for a long time at intervals of 3-4 months.
Botulinum toxin injection is an extremely effective method to relax spastic muscles in stroke. It is supported by medications depending on the situation. Very successful results can be obtained by using intensive physiotherapy in this process. Despite the existence of such a method, it is not applied to the majority of patients. Botulinum toxin treatment, which is covered by state institutions, should definitely be tried in eligible patients. In this way, paralytic contractions in the hands and feet can be prevented and the patient can move much more comfortably and functionally.
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