ABSTRACT
AIMS AND DEVELOPMENT: Spasticity is an important medical problem with a high rate of incidence both in childhood, mainly as a result of cerebral palsy, and in adults, which is frequently brought about by traumatic brain injuries, strokes and spinal cord injuries. Spasticity is part of upper motoneuron syndrome, which gives rise to important problems, such as limited joint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders, among others. It progresses naturally towards chronicity, accompanied by static phenomena due to alterations affecting the properties of soft tissues (elasticity, plasticity and viscosity). Numerous therapeutic options are available for the treatment of spasticity, including medication, physiotherapy, orthopaedic aid, surgery, and so forth. Moreover, treatment should be individualised and realistic, with goals that have been agreed between the patient or caregiver and the medical team. The aim of the following guide is to further our knowledge of this condition, its causes, epidemiology and progression, as well as to outline an approach that is both rational and global from the point of view of pharmacological, rehabilitation and surgical treatment. CONCLUSIONS: Spasticity is a complex problem that requires specialists (neurologist, rehabilitation doctor, occupational therapist, orthopaedic surgeon, general practitioner, etc.) to work as a team in order to achieve the goals set out when treatment is begun. Early treatment is important to avoid or reduce, as far as possible, the severe complications stemming from this condition.
Subject(s)
Muscle Spasticity/therapy , Baclofen/therapeutic use , Cerebral Palsy/physiopathology , Cerebral Palsy/therapy , Disease Progression , Humans , Muscle Relaxants, Central/therapeutic use , Muscle Spasticity/epidemiology , Muscle Spasticity/etiology , Muscle Spasticity/physiopathology , Neuromuscular Agents/therapeutic use , Physical Therapy ModalitiesABSTRACT
Objetivos y desarrollo. La espasticidad constituye un problema médico de incidencia y trascendencia elevada tanto en la infancia, como consecuencia principalmente de la parálisis cerebral, como en adultos, ocasionada frecuentemente por traumatismos craneoencefálicos, ictus y lesión medular. La espasticidad forma parte del síndrome de motoneurona superior que ocasiona problemas importantes, como son: limitación articular, posturas anómalas que pueden generar dolor, alteraciónde la capacidad funcional, alteraciones estéticas o de higiene, entre otras. Su evolución natural es hacia la cronicidad, acompañada de fenómenos estáticos por alteraciones de las propiedades de los tejidos blandos (elasticidad, plasticidad y viscosidad).Las opciones terapéuticas de la espasticidad son múltiples: fármacos, fisioterapia, ayudas ortopédicas, cirugía, etc.Además, el tratamiento debe ser individualizado y realista, con unos objetivos consensuados entre el paciente o cuidador y el equipo médico. El objetivo de la siguiente guía es profundizar en el conocimiento de esta patología, sus causas, epidemiologíay evolución, así como aportar una forma racional y global de abordaje desde el punto de vista del tratamiento farmacológico, rehabilitador y quirúrgico. Conclusión. La espasticidad es un problema complejo que requiere un trabajo en equipo(neurólogo, rehabilitador, terapeuta ocupacional, cirujano ortopeda, médico de familia, etc.) para conseguir los objetivos que se fijan al principio de su tratamiento. Es importante el tratamiento precoz para evitar o reducir, en la medida de lo posible, las graves complicaciones que conlleva
Aims and development. Spasticity is an important medical problem with a high rate of incidence both in childhood,mainly as a result of cerebral palsy, and in adults, which is frequently brought about by traumatic brain injuries, strokes and spinal cord injuries. Spasticity is part of upper motoneuron syndrome, which gives rise to important problems, such as limitedjoint movement, abnormal postures that can produce pain, impaired functional capacity, aesthetic or hygiene disorders, among others. It progresses naturally towards chronicity, accompanied by static phenomena due to alterations affecting the properties of soft tissues (elasticity, plasticity and viscosity). Numerous therapeutic options are available for the treatment ofspasticity, including medication, physiotherapy, orthopaedic aid, surgery, and so forth. Moreover, treatment should be individualised and realistic, with goals that have been agreed between the patient or caregiver and the medical team. The aimof the following guide is to further our knowledge of this condition, its causes, epidemiology and progression, as well as to outline an approach that is both rational and global from the point of view of pharmacological, rehabilitation and surgicaltreatment. Conclusions. Spasticity is a complex problem that requires specialists (neurologist, rehabilitation doctor, occupational therapist, orthopaedic surgeon, general practitioner, etc.) to work as a team in order to achieve the goals set outwhen treatment is begun. Early treatment is important to avoid or reduce, as far as possible, the severe complications stemming from this condition
Subject(s)
Humans , Child , Adolescent , Adult , Muscle Spasticity/therapy , Comprehensive Health Care , Muscle Spasticity/rehabilitation , Muscle Spasticity/physiopathology , Muscle Spasticity/surgery , Patient Care Team , Cerebral Palsy/complications , /methods , Baclofen/administration & dosage , Baclofen/therapeutic useABSTRACT
AIMS: The introduction of botulinum toxin has been a significant step forward in the treatment of spasticity in children and is now considered to be the preferred treatment in focal spasticity. With the aim of optimising this therapeutic resource, a group of Spanish neurologists and specialists in rehabilitation have drawn up these therapeutic guidelines based on the currently available evidence on its use and indications, and on their own experience. DEVELOPMENT: Spasticity in childhood is mainly caused by infantile cerebral palsy. Its natural history is not favourable due to the negative effect of growth and it should be treated before permanent deformities in bones and joints appear. Treatment with botulinum toxin diminishes hyperactivity and muscle tone, and allows the muscle to grow longitudinally, which prevents permanent contractions. The advantages of botulinum toxin are obvious (ease of use and dosing, long-lasting effects, reversibility in case of adverse responses, and so forth) and outnumber by far the few drawbacks it offers. Before it can be used patients, treatment goals and the muscle areas to be treated must all be selected correctly and, at the same time, a tailored rehabilitation scheme must also be developed. The growing body of experience suggests that its early administration is effective in preventing or reducing the severe complications of spasticity. CONCLUSIONS: Botulinum toxin type A is very effective in the treatment of spasticity. These guidelines offer the well-documented experience gained from its use and our knowledge about its indications, effects and safety in clinical practice.
Subject(s)
Anti-Dyskinesia Agents/therapeutic use , Botulinum Toxins, Type A/therapeutic use , Muscle Spasticity/drug therapy , Anti-Dyskinesia Agents/administration & dosage , Botulinum Toxins, Type A/administration & dosage , Child , Humans , Treatment OutcomeABSTRACT
AIMS: The introduction of Botulinum toxin type A (BTA) in the treatment of spasticity in adults was a large step forward in neurology and it is currently seen as the first choice treatment in focal spasticity. In an attempt to achieve the optimisation of this therapeutic resource, different clinical guidelines have been drawn up which include reviews of the evidence available about the indications and use of BTA. Spasticity is characterised by the presence of involuntary muscular hyperactivity that is often associated to pain, deformity and functional disability. From the clinical point of view, the advantages of BTA are obvious (ease of use and dosage determination, long lasting effects, reversibility should the response be inappropriate, etc.) and far outweigh its drawbacks. It can only be used after a proper selection of patients, of the therapeutic aims and of the muscular areas to be treated, and a tailor-made programme of rehabilitation must also be drawn up. Increasing experience in its use suggests that its early administration is effective in preventing or reducing the complications arising from spasticity. CONCLUSIONS: BTA is effective in the treatment of spasticity and plays a significant role if the clinical objectives involve functional aspects. At present a large amount of well-documented experience concerning its indications, effects and safety in clinical practice is already available.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Muscle Spasticity/drug therapy , Neuromuscular Agents/therapeutic use , Adult , Child , Diagnosis, Differential , Humans , Muscle Spasticity/physiopathology , Practice Guidelines as TopicABSTRACT
Objetivos. La introducción de la toxina botulínica A (TBA) en el tratamiento de la espasticidad en los adultos supuso un avance significativo en neurología; en la actualidad, se considera el tratamiento de elección en la espasticidad focal. Para conseguir la optimización de este recurso terapéutico, se han elaborado diferentes guías clínicas en las que se revisa la evidencia disponible sobre las indicaciones y el uso de la TBA. La espasticidad se caracteriza por la presencia de hiperactividad muscular involuntaria que, con frecuencia, se asocia a dolor, deformidad y discapacidad funcional. Las ventajas de la TBA son evidentes desde el punto de vista clínico (facilidad de uso y dosificación, larga duración del efecto, reversibilidad en caso de respuesta inadecuada, etc.) y superan ampliamente sus inconvenientes. Para su empleo se requiere una correcta selección de los pacientes, de los objetivos de tratamiento y de las áreas musculares a tratar y, finalmente, el desarrollo de un plan de rehabilitación personalizado. La creciente experiencia en su uso sugiere que su administración precoz es eficaz para evitar o reducir las complicaciones de la espasticidad. Conclusión. La TBA es efectiva en el tratamiento de la espasticidad y desempeña un papel evidente si los objetivos clínicos son funcionales. Actualmente, existe experiencia bien documentada sobre su uso y se conocen sus indicaciones, efectos y seguridad en la práctica clínica (AU)
Aims. The introduction of Botulinum toxin type A (BTA) in the treatment of spasticity in adults was a large step forward in Neurology and it is currently seen as the first choice treatment in focal spasticity. In an attempt to achieve the optimisation of this therapeutic resource, different clinical guidelines have been drawn up which include reviews of the evidence available about the indications and use of BTA. Spasticity is characterised by the presence of involuntary muscular hyperactivity that is often associated to pain, deformity and functional disability. From the clinical point of view, the advantages of BTA are obvious (ease of use and dosage determination, long lasting effects, reversibility should the response be inappropriate, etc.) and far outweigh its drawbacks. It can only be used after a proper selection of patients, of the therapeutic aims and of the muscular areas to be treated, and a tailor-made programme of rehabilitation must also be drawn up. Increasing experience in its use suggests that its early administration is effective in preventing or reducing the complications arising from spasticity. Conclusions. BTA is effective in the treatment of spasticity and plays a significant role if the clinical objectives involve functional aspects. At present a large amount of well-documented experience concerning its indications, effects and safety in clinical practice is already available (AU)
