Cost of peripheral facial palsy treatment with Botulinum Toxin type A.

INTRODUCTION: Facial palsy (FP) is one of the most common neuropathies. Overall, 15%-30% of patients develop chronic sequelae. Several studies support the use of botulinum toxin A (BoNT-A) in the treatment of FP sequelae. No studies have analyzed the cost of treating FP with BoNT-A. METHODS: A retrospective review of data from all clinical records of consultations and procedures that took place at the FP Treatment Unit clinic throughout 2017. Type of BoNT-A used, total dose used, unilateral or bilateral injection, date of consultation, and gender were collected. The price of expendable materials, BoNT-A, and the 2017 salary scale was obtained to establish costs. RESULTS: During 2017, 605 clinical procedures were conducted in 240 patients. The mean number of procedures was 2.5 (0.80). The average time between procedures was 124(28.72) days. The total annual cost was 34.155,10€. The average annual cost of BoNT-A for each procedure was 39,93€, and the total annual cost of BoNT-A was 24.160,58€. On average, more units of IncotoxA were injected. This difference is not reflected in the final cost of each BoNT-A. For patients who achieved treatment stability, the average annual cost per patient was 106,6€ (OnatoxA) and 100,6€ (IncotoxA). CONCLUSION: In our unit, treatment with BoNT-A in FP sequelae had an average annual cost of 124,31€ per patient, requiring a visit to the hospital to receive treatment every 124 days. Given the functional and quality of life improvements, we should consider that it is a beneficial treatment at an acceptable cost.

Eficacia de la estimulación percutánea versus transcutánea del nervio tibial posterior en pacientes con vejiga hiperactiva / Effectiveness of percutaneous versus transcutaneous tibial nerve stimulation in patients with overactive bladder syndrome

Introducción: La prevalencia estimada de vejiga hiperactiva (VH) varía del 3-43%. Su etiología es desconocida y el diagnóstico es clínico. El tratamiento incluye desde modificaciones comportamentales, fisioterapia, antagonistas de receptores muscarínicos, neuromodulación y toxina botulínica, hasta intervenciones quirúrgicas. Debido a los efectos secundarios del tratamiento farmacológico y, que su eficacia puede reducirse en el tiempo, han cobrado interés las alternativas terapéuticas como la estimulación de nervio tibial posterior (ENTP). El objetivo del presente trabajo es evaluar la mejoría clínica con ENTP, percutánea o transcutánea, en los pacientes con VH. Materiales y métodos: Estudio descriptivo, retrospectivo, con revisión de historias clínicas de los pacientes con VH tratados con ENTP percutánea y transcutánea. Valoramos el diario miccional, la prueba de Sandvik y el International Consultation on Incontinence-Short Form (ICIQ-SF). Resultados: Se incluyeron 34 pacientes con VH, con edad media de 64,5 años. Todas recibieron tratamiento con ENTP, 61,8% transcutánea y 38,2% percutánea. Observamos mejoría en la frecuencia miccional nocturna, prueba de Sandvik e ICIQ-SF (p < 0,001), sin diferencia estadística entre grupos. Todas las pacientes se encontraron satisfechas con el tratamiento y el 100% completaron el mismo. Discusión: La ENTP se considera una técnica sencilla, mínimamente invasiva, de fácil aplicación y bien tolerada, que ha demostrado ser un método eficaz de tratamiento, sin efectos secundarios reseñables. Mejora la calidad de vida del paciente con una adecuada adherencia al tratamiento. No hemos podido demostrar que la ENTP percutánea sea más eficaz que la transcutánea (AU)

Introduction: The estimated prevalence of overactive bladder (OAB) ranges from 3 to 43%. The cause is unknown and diagnosis is clinical. Treatment includes behavioral changes, physical therapy, muscarinic receptor antagonists, neuromodulation and botulinum toxin, and surgical procedures. Because of the adverse effects of pharmacologic treatment and its diminished effectiveness over time, therapeutic alternatives such as tibial nerve stimulation have attracted increasing interest. The aim of this study was to evaluate clinical improvement with percutaneous or transcutaneous tibial nerve stimulation in patients with OAB. Materials and methods: A descriptive study was performed through a retrospective review of the medical records of patients with OAB treated with transcutaneous or percutaneous tibial nerve stimulation. We evaluated a 3-day Bladder Diary, the Sandvik Test and the International Consultation on Incontinence-Short Form (ICIQ-SF). Results: We included 34 patients with OAB, with a mean age of 64.5 years. All the patients were treated with tibial nerve stimulation (transcutaneous in 61.8% and percutaneous in 38.2%). Nocturnal urinary frequency, the Sandvik test and the ICIQ-SF all showed improvement (P<.001), with no significant statistical difference between the groups. All the patients completed the treatment and all reported satisfaction. Discussion: Tibial nerve stimulation is considered a simple, minimally invasive, easy to apply and well tolerated method that has proved to be effective with no marked adverse effects. This treatment improves the patient’s quality of life and treatment adherence is adequate. We were unable to demonstrate that percutaneous tibial nerve stimulation was more effective than transcutaneous stimulation (AU)

Síndrome de Kabuki: una enfermedad con pronóstico heterogéneo / Kabuki syndrome: a disease with a heterogeneous prognosis

El síndrome de Kabuki es una enfermedad poco frecuente y de presentación clínica muy variable. Su diagnóstico se basa fundamentalmente en los hallazgos clínicos. El objetivo de este trabajo es presentar 2 casos clínicos del mismo síndrome con diferencias clínicas, evolutivas y pronósticas. El primer caso se trata de una niña evaluada en nuestro servicio con casi 10 años de edad, sin tratamiento médico previo, antecedentes de una cardiopatía compleja severa, fenotipo característico e hipotonía severa generalizada. El segundo caso es una niña en seguimiento por nuestro servicio desde los 5 meses, con fenotipo característico, hipotonía leve-moderada y retraso del desarrollo psicomotor. En ambos casos el tratamiento rehabilitador consigue mejorar su situación clínica aunque tienen una evolución muy diferente. El tratamiento debe ser individualizado, la intervención terapéutica precoz condicionará su evolución y pronóstico (AU)

Kabuki syndrome is a rare disease with a highly variable clinical presentation. Diagnosis is mainly based on clinical findings. This report aims to present two cases of the same syndrome with different clinical presentation and outcome. The first case was a girl first evaluated in our department when she was nearly 10 years old, with no previous medical treatment. She had a severe complex heart disease, characteristic phenotype and severe generalized hypotonia. The second case was a girl who had been followed-up in our department since she was 5 months old, with characteristic phenotype, mild-moderate hypotonia and developmental delay. In both patients, rehabilitation improved their clinical status, although outcome differed in each. Treatment of Kabuki syndrome should be individualized and early therapeutic intervention will affect its clinical course and outcome (AU)