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.

[Early pharmacologic treatment with botulinum toxin A in post-stroke spasticity: consensus evidence-based recommendations]. / Tratamiento farmacologico temprano de la espasticidad postictus con toxina botulinica tipo A: recomendaciones de consenso basadas en la evidencia.

Spasticity is a common complication that occurs in those patients that have suffered a stroke. To identify those patients at high risk of having post-stroke spasticity and to start treatment at early stages would probably benefit the patient. The key aspects in the early management of post-stroke spasticity were review and the clinical implications and strength of evidences were also considered. The document drafted by the study coordinators was subsequently reviewed and then a validated document was developed. The experts recommend defining early treatment of spasticity as one that begins before the first three months after stroke. The panel considers very important to identify the risk factors associated with the onset of spasticity, since this might reduce its impact. Additionally, the most common conditions subsidiaries of early treatment of both upper and lower limb are defined. The panel recommends that the treatment with botulinum toxin A must only be given by specialists with experience in diagnosis and management of spasticity. In conclusion, the treatment of focal spasticity in the first three months after stroke is indicated in certain situations. These recommendations help to standardize the early management of post-stroke spasticity, with the consequent support to clinicians and patients.

TITLE: Tratamiento farmacologico temprano de la espasticidad postictus con toxina botulinica tipo A: recomendaciones de consenso basadas en la evidencia.La espasticidad es una secuela comun en los pacientes que han sufrido un ictus. La identificacion de pacientes con alto riesgo de presentar espasticidad postictus e iniciar el tratamiento en fases tempranas probablemente beneficiaria al paciente. Se revisaron las areas clave en el manejo temprano de la espasticidad postictus, y se consideraron las implicaciones clinicas y la solidez de las evidencias. El documento elaborado por los coordinadores fue sometido a revision y se elaboro un texto, que finalmente se valido. El grupo de expertos recomienda definir el tratamiento temprano de la espasticidad como el que comienza antes de los tres primeros meses tras el ictus. El panel considera muy importante identificar los factores de riesgo asociados con la aparicion de la espasticidad, ya que esto podria reducir su impacto. Se definen las situaciones mas frecuentes subsidiarias de tratamiento precoz tanto del miembro superior como del miembro inferior. El panel recomienda que el tratamiento con toxina botulinica tipo A sea administrado por especialistas que posean una amplia experiencia en el diagnostico y manejo clinico de la espasticidad. En conclusion, el tratamiento de la espasticidad focal en los primeros tres meses tras un ictus esta indicado en determinadas situaciones. Estas recomendaciones ayudan a estandarizar el manejo temprano de la espasticidad postictus, con la consiguiente ayuda para el clinico y los pacientes.

Mioplastia de elongación de músculo temporal para rehabilitación de parálisis hemifacial / Temporalis lengthening myoplasty for rehabilitation of hemifacial paralysis

La parálisis facial permanente es una de las secuelas más importantes en patología maxilofacial. La técnica quirúrgica que se presenta modifica el punto fijo temporal y transpone el punto móvil de la coronoides a los labios. El músculo temporal se transfiere en su totalidad con preservación de su pedículo. Se describe el tratamiento rehabilitador realizado. La redistribución de las fibras musculares a expensas de su tercio posterior es un hallazgo descrito por Labbé y hace posible la obtención del elongamiento necesario para la distancia entre el proceso coronoides y la comisura labial. Este procedimiento, más fácil, rápido y de cuidados postoperatorios más simplificados que la rehabilitación microquirúrgica, permite una sonrisa voluntaria independiente de los movimientos mandibulares(AU)

Permanent facial paralysis is one of the most important sequelae of maxillofacial surgery. The surgical technique presented here modifies the point of temporal insertion and transposes the mobile coronoid point to the lips. The entire temporalis muscle with pedicle is transferred. The rehabilitation is described. Redistribution of the muscle fibers at the expense of the posterior third of the muscle was reported by Labbé and makes it possible to obtain the lengthening required to bridge the distance between the coronoid process and lip commissure. This procedure is easier, quicker and has more simplified postoperative care than microsurgical rehabilitation, while resulting in a voluntary smile independent of mandibular movements(AU)

Resultados funcionales de la simbraquidactilia tratada quirúrgicamente / Functional results of surgery treated symbrachydactyly

La agenesia digital es una malformación congénita, también conocida como simbraquidactilia. Clínicamente varía desde aplasia de una o varias falanges intermedias hasta fragmento de mano con adactilia. El objetivo final del tratamiento es la funcionalidad de la mano, realizar pinza fina, permitiendo la integración escolar, familiar y social del niño. Mostramos los resultados funcionales de algunos casos tratados en nuestro Servicio de Rehabilitación tras ser intervenidos por el Departamento de Cirugía Plástica, y analizamos algunos aspectos como función de la mano, edad de la cirugía, función del pie/marcha, factores psicológicos y estética de la mano(AU)

Digital agenesia is a congenital malformation also known as symbrachydactyly. Clinical features may vary from one o more medium phalanx aplasia to one hand fragment with adactyly. The final goal of the treatment is to achieve hand function with grasp improving thus permitting the child academic, family and social integration. We show the functional results archieved by the cases treated in our Rehabilitation Unit after surgery repair has been done by Plastic Surgery department, and we have analysed several aspects such as: hand function, age of surgery, toe function/walking, psychological factors and appearance of the hand(AU)

Estudio prospectivo randomizado de comparación de diferentes técnicas de electroterapia en tendinitis de inserción en codo / Elbow tendinosis treated by several electrotherapy techniques: a prospective randomized study

Introducción: La epicondilitis es una patología muy frecuente en los Servicios de Rehabilitación. Aunque la rehabilitación permite un manejo eficiente de los pacientes, se utilizan diferentes tratamientos, existiendo pocos estudios comparativos de su eficacia. Pacientes y método: Se siguió en el tiempo una cohorte de 84 pacientes. La media de edad fue de 44,9 años. En todos ellos se aplicaron escalas analógicas visuales (EVA) de dolor y funcionalidad. Además se realizó una evaluación según la escala DASH (Disability of the Arm Shoulder and Hand). Tras obtener consentimiento los pacientes fueron aleatoriamente asignados a uno de los grupos de tratamiento: crioterapia, electroforesis, laser, sonoforesis, ultrasonoterapia, seguido de dos meses de ejercicios, tras los cuales eran reevaluados. Para el estudio estadístico se utilizó un sistema de investigador ciego. Resultados: la media de la EVA de dolor antes de tratamiento fue de 5,08 y de funcionalidad 4,55. La media de la escala DASH 69,14. Después del tratamiento la EVA de dolor disminuyo a 3,23 y la de función a 2,84. La media de DASH al finalizar era de 54,61. Aunque la diferencia pre y post-tratamiento fueron significativas (p<0,05), no pudimos demostrar diferencias entre los distintos grupos de electroterapia. Conclusión: electroterapia y ejercicios de estiramiento forman una terapia efectiva en el tratamiento de las epicondilitis. No hemos podido demostrar diferencias entre los distintos tipos de electroterapia utilizados

Introduction: Epicondylitis is commonly seen in Rehabilitation Departments. Although physical rehabilitation is an important and efficient tool for the management of this condition a large number of modalities are being used. On the other hand there are few studies comparing the different therapeutic modalities. Patients and methods: A prospective cohort of 84 patients was analyzed. Their average age was 44.9 years. In all cases, visual analogic scales (VAS) were used to assess pain and function. Moreover, patients were evaluated according to the Disability of Arm, Shoulder and Hand (DASH) scale. After inform consent, patients were randomly included to one of the following treatment groups: cryotherapy, electrophoresis, laser therapy, sonophoresis and ultrasound therapy followed by two months of stretching exercises, after which the patients were reevaluated. For statistical purposes a blinded research method was used. Results: The VAS pain score before treatment was 5.08 points and the VAS function score 4.55 points. The mean overall score of the DASH scale was 69.14 points. After treatment VAS pain scale decreased to 3.23 and VAS function scale to 2.84. The DASH scale at the end was 54.61 points. Although the differences before and after treatment were significant (p<0.05) we couldn’t find significant differences between the various modalities of electrotherapy. Conclusions: Electrotherapy and stretching exercises are effective in the treatment of elbow tendinoses. However, we couldn’t demonstrate differences between the different modalities of electrotherapy used in this study