Treatment of spasticity in spinal cord injury with botulinum toxin.

CONTEXT: Spasticity is one of the most frequent complications in spinal cord injury (SCI), and is routinely managed with oral pharmacologic therapy. Botulinum toxin (BT) is not accepted as a treatment for spasticity in SCI in Spain but may be used in certain cases of focal distribution. OBJECTIVE: To report the results with BT for treatment of spasticity in SCI. DESIGN AND SETTING: Descriptive retrospective study conducted at a specialist SCI rehabilitation center in Spain, covering patients first treated from 2012 through 2014, and successfully followed up for a minimum of 1 year. Data were collected on the following variables: demographic and SCI characteristics (level and grade); nature of spasticity, e.g. tone, distribution, spasms, articular involvement and pain; function; application of BT; tolerance and adverse reactions. RESULTS: The study covered 90 patients, predominantly male with incomplete injuries. Improvement in tone as measured by the modified Ashworth scale was a mean of 1.17 points. Goniometric improvement was achieved in 65.6% and improvement in pain in 38.9% of cases. There were no adverse side-effects. Patients with focal spasticity showed a significantly greater improvement in tone (P < 0.0001). The earlier the BT injection, the greater the improvement in goniometric performance (P < 0.006) and pain (P < 0.033), with the best results being obtained within the first 6 months of clinical course. ASIA D injuries showed a greater improvement in tone (P < 0.0001). CONCLUSIONS: BT can be both an effective treatment for focal spasticity in SCI and a good coadjuvant for oral treatments in generalized spasticity.

[Spinal cord injury in patients over 65 years of age]. / Lesión medular en pacientes mayores de 65 años.

INTRODUCTION: Physically active population over 65 years old is increasing, they are at risk of falls and spinal cord injury in a range of age with significant presence of chronic pathology. AIM: To review the incidence, type of injury, associated complications and functional recovey of spinal cord injury in patients over 65 years. PATIENTS AND METHODS: Retrospective descriptive study about patients over 65 years admitted in Hospital Nacional de Paraplejicos with spinal cord injury from January 2010 to December 2011. Demographic and lesion data, complications during admission and fuctional recovery measured with SCIM III (Spinal Cord Independence Measure) and WISCI II scales (Walking Index Spinal Cord Injury) were reviewed. RESULTS: 111 patients were included, mean age was 72.5 years, 33.3% were cervical injury and 66.7% were incomplete injuries, medical disease was more frequent than traumatic disease. Only 5% did not present other associated diseases. Up to 97% suffered some complications. SCIM III average was 42 points and only 35% got walking function. CONCLUSIONS: There has been an increase in aging spinal cord injury patients in recent years. Unlike general population traumatic etiology is not more frequent than medical. Incomplete injuries are common and usually associated with more comorbility, getting poorer functional recovery despite neurological improvement.

TITLE: Lesion medular en pacientes mayores de 65 años.Introduccion. La poblacion de mayores de 65 años activos fisicamente continua en aumento, lo que condiciona un mayor riesgo de caidas y de lesion medular en un rango de edad con importante presencia de patologia cronica. Objetivo. Revisar la incidencia, el tipo de lesion, las complicaciones asociadas y los resultados funcionales de las lesiones medulares ocurridas en pacientes mayores de 65 años. Pacientes y metodos. Estudio descriptivo retrospectivo en lesionados medulares agudos mayores de 65 años ingresados en el Hospital Nacional de Paraplejicos desde enero de 2010 hasta diciembre de 2011. Las variables del estudio fueron datos demograficos y de lesion, antecedentes personales, complicaciones ocurridas durante el ingreso y capacidad funcional al alta medida con las escalas Spinal Cord Independence Measure (SCIM III) y Walking Index Spinal Cord Injury (WISCI). Resultados. Se incluyeron 111 individuos con una media de edad de 72,5 años. La incidencia anual fue de 17,3 pacientes/100 ingresos. El 33,3% eran lesiones cervicales y fueron incompletas el 66,7%. La etiologia medica fue mas frecuente que la traumatica. El 5% no presentaba otras enfermedades intercurrentes. El 97% sufrio algun tipo de complicacion. La media alcanzada para la SCIM III fue de 42 puntos y el 35% consiguio capacidad de marcha. Conclusiones. En los ultimos años se ha producido un aumento de lesion medular en mayores de 65 años, en los que la etiologia traumatica no es superior a la medica; mas frecuentemente son lesiones incompletas que asocian mayor comorbilidad que la poblacion general, y se consiguen resultados funcionales mas pobres a pesar de las mejoras neurologicas.