ABSTRACT
Botulinum neurotoxin is widely used to treat a variety of movement disorders, especially dystonia and spasticity. There botúlica different preparations of botulinum type A, that because biologics are difficult to compare. AbobotulinumtoxinA (Dysport ®) has recently been introduced in Chile for treating dystonia and spasticity. The aim of this paper is to provide a review by experts on the existing evidence and propose a practical guide to the use of the drug. Methods and Results: A group of Chilean experts met on 6 and 7 July 2012 to review AbobotulinumtoxinA doses along with injection protocols for dystonia, spasticity and other movement disorders. We worked in two groups, one composed of neurologists who reviewed the on dystonias and other by physiatrists who reviewed the indications for spasticity. Conclusions: Finally, there is a proposal in terms of dose, injection points and recommendations for dystonia and spasticity...
La neurotoxina botulínica es ampliamente usada para tratar una variedad de trastornos del movimiento, especialmente la distonía y la espasticidad. Existen diferentes preparados de toxina botúlica tipo A, que por ser productos biológicos resultan difícilmente comparables. La abobotulinumtoxinA (Dysport®) ha sido introducida en Chile recientemente para el tratamiento de la distonía y la espasticidad. El objetivo de este trabajo es entregar una revisión hecha por expertos sobre la evidencia existente y plantear una guía práctica para el uso del medicamento. Métodos y Resultados: Un grupo de expertos chilenos se reunieron el 6 y 7 julio de 2012 para revisar las dosis abobotulinumtoxin A, junto con los protocolos de inyección para la distonía, la espasticidad y otros trastornos del movimiento. Se trabajó en dos grupos, uno compuesto por neurólogos que revisaron las indicaciones en distonías y otro por fisiatras que revisaron las indicaciones para espasticidad. Conclusiones: Finalmente, se realiza una propuesta en cuanto a dosis, puntos a inyectar y recomendaciones para la distonia y espasticidad...
Subject(s)
Humans , Dystonia/drug therapy , Muscle Spasticity/drug therapy , Neuromuscular Agents/administration & dosage , Botulinum Toxins, Type A/administration & dosage , Chile , Consensus , Evidence-Based Medicine , Neuromuscular Agents/adverse effects , Practice Guidelines as Topic , Botulinum Toxins, Type A/adverse effectsABSTRACT
Background: The Functional Independence Measure (FIM) is an instrument widely used to assess the results and progress of a medical rehabilitation program. Aim: To assess the inter rater agreement in the application of FIM and show the clinical experience with its use in disabled patients enrolled in a rehabilitation program. Patients and methods: FIM was applied in 40 patients and the inter rater agreement was assessed, comparing raters with and without training in its use. Agreement was evaluated using Kappa test. Afterwards, the FIM was used to assess changes in 100 patients hospitalized and being rehabilitated at the rehabilitation ward of a general hospital. Results: Inter rater agreement is high in physical areas of the FIM and low in cognitive areas. Training significantly improves agreement in communication and cognitive areas. During a mean period of hospitalization of 38 days, FIM score changed from a mean of 47.2 to 92 points, with an improvement of 1.18 points per hospitalization day. The higher improvement was achieved in the physical area of the instrument. Conclusions: Training is required for a proper application of FIM. When used adequately, this instrument allows an assessment of the degree of disability and the changes obtained with rehabilitation programs