Research progress of Chinese and Western medicine on spastic cerebral palsy in children in recent ten years

Song Liu,Xiao-Ying lv,Hui Wang,Li-Yun He＊

1The First College for Clinical Medicine,Shaanxi University of Chinese Medicine,Xianyang 712000,China.2Institute Of Basic Research in Clinical Medicine,China Academy of Chinese Medical sciences,Beijing 100000,China.3No.7 Encephalopathy Department,Xi'an TCM hospital of encephalopathy,Xi’an 710000,China.

Abstract In recent ten years,with more and more children with spastic cerebral palsy appearing around us,relevant clinical research has also become a research hotspot.However,at present,there is no radical plan for the treatment of children with spastic cerebral palsy in the world.This study summarizes the latest progress of traditional Chinese and Western medicine in the treatment of children with spastic cerebral palsy in recent years,hoping that the whole work can serve as a clinical and theoretical basis and provide certain reference significance.

Keywords:cerebral palsy,spastic cerebral palsy,traditional chinese and western medicine,treatment

Background

Cerebral palsy(CP)is a persistent group of central motor and postural dysplasia and restricted movement syndrome,which is caused by non-progressive brain damage in a developing fetus or infant.Motor disorders in cerebral palsy are often accompanied by sensory,perceptual,cognitive,communication and behavioral disorders,as well as epilepsy and secondary musculoskeletal problems[1,2].So far,the cause of cerebral palsy is still unclear,but many high risk factors associated with cerebral palsy have been found in clinical practice.According to the characteristics of time,these factors can be divided into antenatal,delivery and postpartum three parts.At present,most experts believe that prenatal factors are the main factors.It is mainly preterm birth or low birth weight,neonatal asphyxia or hypoxic ischemic encephalopathy[3].The clinical classification of cerebral palsy is mainly divided into spastic,involuntary sports,ataxia,mixed type,among which spastic type is divided into quadriplegia,double paralysis,hemiplegia.Spastic cerebral palsy is the main type of cerebral palsy in children,accounting for 60% - 70% of all children with cerebral palsy.Its clinical manifestations are:the cone system is mainly damaged,including cortical motor area injury.Hypertonic hyperlexia is characteristic of this type.Increased muscle tension of limbs,lower limbs or one limb,upper extremity dorsiflexion,adduction,internal rotation,thumb adduction,trunk flexion,lower extremity adduction,internal rotation,cross,knee flexion,scissor step,pointed foot,foot pronation,arch dorsiflexion,tendon hyperreflexes,ankle clonus,knife sign and cone bundle sign,etc.In traditional Chinese medicine(TCM),the name of "spastic cerebral palsy" was not found in ancient books,but only the disease categories of "Five Late","Five Soft" and "Five Hard"(Five Late,Five Soft,Five Hard children growth and development disorders.Five Late for late,late language,late hair,late teeth;Five Soft for soft head,soft mouth,soft hands,soft feet,soft muscles;The Five Stiffnesses are stiff head,hands,feet,waist and muscles.),which have the same manifestations with "spastic cerebral palsy"[4].At present,there is no radical treatment for spastic cerebral palsy,only to improve function,which is a world-class problem and a thorny problem for all doctors.However,with the development of clinical research and the update of science and technology,more and more therapeutic means and therapeutic devices have emerged in this field in recent years,and great progress has been made.Its main force is still mainly focused on the relief of spasticity.The treatment is mainly acupuncture and moxibustion,massage,internal and external use of TCM and catgut embedding,operation,functional training,physical therapy and drug therapy of Western medicine.It is worth noting that in recent years,combined treatment is a good breakthrough,such as acupuncture and moxibustion of TCM combined with surgical treatment of Western medicine is a good example.This article reviews the new progress in the treatment of spastic cerebral palsy in various fields in recent years to provide evidence for clinical and scientific research.

TCM treatment of spastic cerebral palsy

Acupuncture

Acupuncture is one of the TCM,in the treatment of diseases can play the role of activating "Meridians"(a system of transportation,transmission and regulation composed of channels，collaterals and their affiliated organs and tissues.),regulating Qi(Qi is the nourishment of all the activities of tissues and organs.)and blood.By acupuncture key points of the cerebral palsy children with spastic type such as Baihui(DU20),Sishencong(EX-HN 1),Fengchi(GB20),Dazhui(DU14),Fengfu(DU16),Mingmen(DU4),Ganshu(BL18),Pishu(BL20),Taichong(LR3),Taibai(SP3),Yanglingquan(GB34),Sanyinjiao(SP6),needle head strong stimulation,body acupuncture catharsis,or flat of residual hole is more flat,Beishu Point(Beishu Point refers to the injection of Qi from the viscera into the back.)not retaining needle acupoints,choose acupuncture point should give priority to with Yang Ming,less Yang meridians,let the bullishness of lingers,improve blood circulation,So as to improve the muscle strength and function of the limbs[5,6].Liu Zhihua et al.discussed the effect of acupuncture combined with language training in the treatment of children with cerebral palsy,and the results showed that acupuncture and language training could better restore the language function of children with cerebral palsy,and the specific rehabilitation effect was affected by different factors[7].Dai Mengyuan et al.randomly divided 84 children into two groups[8].The control group was treated with conventional drugs and Bobath method,and the treatment group was combined with scalp acupuncture on the basis of the control group.Li Suzhen et al.studied the treatment of spastic cerebral palsy by acupuncture at Du Meridian points combined with neurodevelopmental rehabilitation,and the results showed that the treatment had significant effects on the functional disorders,cerebral blood circulation and neurotransmitter levels of children[9].Zheng Liya et al.treated spastic cerebral palsy by wake up the orifices and dredge the governor acupuncture combined with biological electrical stimulation,which could further improve the therapeutic effect compared with conventional rehabilitation therapy,and was worthy of popularization and application[10].At the same time,acupotomy is also effective in the treatment of spastic cerebral palsy dyskinesia,which can improve motor function and is safe and reliable[11].Leng Qingying et al.studied that the firing needle acupuncture of biceps brachii can effectively improve the degree of biceps brachii spasm and reduce muscle tension in children with spastic cerebral palsy,which is also a good study[12].There have also been studies on the application of "brain and abdominal four-needle" combined with emG biofeedback therapy in the treatment of spastic cerebral palsy,which has effectively improved the muscle strength,spasm degree and motor function of lower limbs in children,and is worthy of further clinical promotion[13].Bao Xuefei et al.used Ziwuliuzhu Acupuncture(Ziwuliuzhu Acupuncture is based on the operation state of Qi and Blood of the twelve meridians,combined with different time changes and corresponding ups and downs,timely selection of acupoints for treatment.)combined with rehabilitation training to improve the gross motor function and muscle tension level of school-age children with spastic cerebral palsy,and improved the quality of life,which is worthy of clinical promotion and application[14].

Massage

Massage is also a part of traditional medicine,can relax the muscles,relieve spasm,only the use of massage in the treatment of children with spastic cerebral palsy,or on the basis of other treatments combined with massage in children with spastic cerebral palsy are quite effective.Clinically,according to the specific condition of different patients,specific limbs dyskinesia,choose a different technique,through the meridians of the courses of massage,acupuncture point according to,knead ridge,and massage,make the viscera Qi and blood circulation,relieve muscle spasm,articular mobility increases,thus promotes the functional recovery of cerebral palsy children with spastic type[15,16].Wang Qiong et al.[17]discussed the efficacy of acupuncture combined with rehabilitation training in the treatment of spastic cerebral palsy in children,and the results were satisfactory.

TCM

TCM as the treasure of traditional medicine,its mechanism is mainly guided by the basic theories of TCM.In the treatment of spastic cerebral palsy in children,TCM can be divided into internal and external use.For example,Yu Xieli et al.studied the efficacy of rehabilitation training combined with Huangqi Guizhi Wuwu Decoction(Figure 1)in the treatment of children with spastic cerebral palsy,and the results showed that TCM could significantly improve limb spasm and walking balance function[18].External application of TCM in the treatment of children with spastic cerebral palsy has a significant effect and can improve motor function.For example,TCM meridian sticking method:Danggui(Radix Angelicae Sinensis)15g,Baizhu(Rhizoma Atractylodis Macrocephalae)15g,Baishao(Radix Paeoniae Alba)15g,Mugua(Fructus Chaenomelis)15g,Chuanxiong(Rhizoma Chuanxiong)15g,Sigualuo(Retinervus Luffae Fructus)20g ,Maqianzi(Semen Strychni)3g,Dingxiang(Flos Caryophylli)15g,Bingpian(Borneolum Syntheticum)3g,it can improve the limb motor function of children with spastic type cerebral palsy[19].Chinese medicine bath treatment of spastic cerebral palsy can reduce the muscle tension of children.TCM wax therapy has also achieved results in children with spastic cerebral palsy.This method can also reduce muscle tension to a certain extent and improve the motor function of children[20-22].Hu Xiaoli et al.discussed the efficacy of TCM fumigation and washing combined with massage combined with exercise therapy in children with spastic cerebral palsy,and the results showed that TCM fumigation and washing significantly improved the range of motion and quality of life of children[23].

Figure 1 ：The Composition Chart of Huangqi Guizhi Wuwu Decoction.

Acupoint Injection

Acupoint injection is a combination of therapy.Drugs are injected into corresponding acupoints and combined with the effects of drugs on the basis of acupoint acupuncture.The two effects are superimposed on each other to improve the effect.Wang Faming et al.discussed the clinical efficacy of acupoint injection in the adjuvant treatment of children with spastic cerebral palsy,and the results showed that mouse nerve growth factor can improve the limb movement ability,improve the spastic state,and improve the brain level[24].Yang Jie et al.discussed the clinical efficacy of acupoint injection of ganglioside combined with routine rehabilitation training in the treatment of children with cerebral palsy,and the results showed that acupoint injection of ganglioside combined with routine rehabilitation training can significantly improve the comprehensive ability of children with spastic cerebral palsy[25].

Treatment of spastic cerebral palsy with Western Medicine

Medication

Up to now,BotulinumtoxinA(BonT-A),monosialic acid tetra-hexose ganglioside and so on are the main drugs for the treatment of spastic cerebral palsy.Bont-A mainly alleviates muscle spasm,reduces muscle tension,and corrects spastic limbs and abnormal postures.Bont-a injection therapy combined with rehabilitation function training is more effective than rehabilitation function training alone,reducing muscle tension,improving range of motion of joints,and improving limb motor function in children with spastic cerebral palsy[26].Sodium monosialate teh hexosaccharide ganglioside mainly protects the secondary neurodegeneration after injury.Sodium monosialate teh hexosaccharide ganglioside injection combined with rehabilitation training is also more effective than simple rehabilitation training,and its fine motor function is improved[27].

Surgery

Currently,surgery is a long-term and effective treatment for children with spastic cerebral palsy,and has been widely used in many children.Including Selec-tive posterior rhizotomy(SPR),microsurgery and so on.Among them,SPR is the most widely used and the most reliable.SPR effectively cuts the corresponding nerve through certain electrical stimulation.Compared with traditional surgery,SPR has great advantages,but it still requires certain rehabilitation training[28,29].Zhao Heqian et al.studied the application of microneurosurgery in the treatment of children with spastic cerebral palsy,and the results showed good results,which can be promoted in clinical practice[30].

Exercise therapy

Exercise therapy is a kind of treatment mainly aimed at improving motor function,which is widely used and has remarkable therapeutic effect.Its main mechanism is to inhibit the nerve reflex of abnormal posture,lead to the occurrence of normal movement,improve the range of motion of joints,and improve the function of the brain.According to different theories,many schools have been formed,such as Vojtal method,Bobath method,Rood method,etc.[31].Vojta method:Also known as induction therapy,it is mainly to stimulate a part of the body to induce children to have some reflex behaviors,and finally complete some correct postures,such as crawling and turning over,to improve the effect of motor function of children.The treatment is aimed at children under two years of age who are unable to roll over and crawl.Bobath method:By stimulating key parts of the body to inhibit abnormal movement patterns and postures,it is suitable for most children with cerebral palsy.The advantage is that different techniques can be used for each type of cerebral palsy,so as to achieve good therapeutic results.Rood method:This method is to control the sensory input on the skin of the body and stimulate the behavior pattern of children,so that children's wrong motor reflex is constantly corrected,constantly stimulate the brain,produce a memory of movement,so as to achieve the effect of rehabilitation.

Occupational therapy

Compared with other treatments,occupational therapy is more convenient.Recreational activities with children with spastic cerebral palsy involve their whole body organs,especially the brain,and ultimately promote the development of the brain and coordination and improvement of motor function,which has a significant effect.Tang Jinghua et al.studied the effect of group exercise therapy on fine motor function of children with cerebral palsy[32].The control group was treated with routine exercise therapy,and the observation group was treated with group exercise therapy,and the results showed that fine motor function of the observation group was significantly improved.

Treatment of spastic cerebral palsy with integrated traditional Chinese and western medicine

With the vigorous development of medical science,the treatment of spastic cerebral palsy has emerged one after another,among which the treatment of integrated traditional Chinese and Western medicine has gradually come to the fore,attracting the attention of traditional and modern medical experts at home and abroad.It gives full play to the strengths of both,but lacks the weaknesses of both,and brings good news to doctors,patients and their families all over the world.Shi Jiangang et al.studied the treatment of spastic cerebral palsy with bushenjian Nao capsule on the basis of conventional treatment in Western medicine,and the results showed significant clinical efficacy[33].Liu Yongping et al.studied the lumbosacral SPR combined with local fumigation and medicinal bath in the treatment of spastic cerebral palsy,and the results showed that spastic cerebral palsy can effectively reduce muscle tension and improve motor function,which is worthy of clinical promotion[34].Game therapy combined with rehabilitation training has also been used to improve the language barrier and cerebral blood perfusion status of children with spastic cerebral palsy,with good results[35].Liu Hongxing et al.also discussed the effect of kidney-tone-brain acupuncture combined with exercise therapy in the treatment of spastic cerebral palsy,and the results showed that it could reduce the severity of the disease in children with spastic cerebral palsy,the mechanism of which may be related to the increase of serum NGF(Nerve Growth Factor)and BDNF(Brain-derived Neurotrophic Factor)levels[36].

Conclusion

To sum up,there have been a lot of means for the treatment of spastic cerebral palsy,especially the combination of various treatment methods has become a big trend,we should try to avoid relying on a certain treatment,so as not to ignore some important symptoms,but also pay attention to the differentiation of TCM syndrome and western medicine symptoms.According to Chinese medicine dialectical classification,spasm cerebral palsy belongs to spleen deficiency and liver prosperous Syndrome,it is mainly manifested in lying more and moving less since birth,strong and soft neck,rigidity and contracture of limbs,tough and useless,or clumsy movements,thin muscles,irritability and irritability,less appetite and stupidity,fat or thin tongue,white and greasy tongue or less moss,weak pulse or heavy string,and stagnant fingerprint.The main principles of treatment is to soften the liver and strengthen the spleen,relax the tendons and relieve spasmolysis by external/internal using of Chinese medicine or acupuncture and manipulation therapy.More and more experts and scholars have paid attention to the treatment of cerebral palsy by TCM.In addition,there have been more and more high-quality clinical studies in this field.This brings hope for children with spastic cerebral palsy and their families.However,the treatment of spastic cerebral palsy is still a major problem in the field of child rehabilitation.Many new treatment methods have appeared,bringing a turning point to this disease,but there is still a great distance from cure.In TCM treatment,we should also pay attention to the mining of clinical efficacy and evaluation methods.It is particularly important to analyze the specific effects of each Chinese medicine and each acupoint,and to pay attention to the side effects for the treatment of spastic cerebral palsy.Due to the limited role of western medicine treatment,it can only relieve symptoms and improve functions,without fundamental curative effect.Therefore,a variety of treatments and cross-association of multiple disciplines are the direction of future development.Although pediatric cerebral palsy is a non-progressive disease,its various symptoms are long-term,complex and intractable.In its treatment,early detection,early treatment,long-term persistence and multiple methods should be used.In the future development of the treatment of spastic cerebral palsy,only by adhering to the diagnosis and treatment mode of integration of traditional Chinese and western medicine and interdisciplinary development can we promote the major breakthroughs and discoveries in the treatment of spastic cerebral palsy and improve the quality of life and family happiness of children.