Espasticidad tras ictus: ¿la edad es un factor de riesgo? Estudio observacional de la espasticidad en pacientes neurovasculares en una serie retrospectiva de dos centros / Stroke spasticity: is age a risk factor? Observational study of spasticity in neurovascular patients in a retrospective series of two health sites

ANTECEDENTES Y OBJETIVO: Aproximadamente un tercio de los pacientes que han sufrido un ictus desarrollan espasticidad. Ante la impresión clínica por parte de los autores de menor proporción de pacientes espásticos entre la población de mayor edad tras un ictus y la falta de consenso en la literatura, se procedió a contrastar aquellas variables que influyen en el desarrollo de espasticidad a partir de los datos de dos centros de neurorrehabilitación. El objetivo del estudio es determinar los factores que influyen en el desarrollo de la espasticidad a los tres meses de evolución del ictus y la prevalencia de espasticidad en los pacientes que han sufrido un ictus y que requieren tratamiento rehabilitador intensivo. MATERIAL Y MÉTODO: Estudio retrospectivo observacional de 554 pacientes atendidos en dos centros de neurorrehabilitación. Se recogieron datos sociodemográficos; naturaleza, etiología y localización del ictus; déficit motóricos, sensitivos, del lenguaje y deglución; incontinencia; estado cognitivo y anímico. El grado de espasticidad se evaluó al ingreso y al tercer mes en 462 pacientes mediante la escala de Ashworth. Se empleó el análisis de regresión multivariante para determinar qué variables influyen en la evolución de la espasticidad al tercer mes de la instauración del ictus. RESULTADOS: Edad media: 67,3 años; 67,1%, de estos eran hombres; 76,5% tuvo un origen isquémico. Al ingreso el 31,4% de los pacientes presentaban espasticidad y a los tres meses el 54,8%. Los pacientes con un mayor índice motor al ingreso, mejoraban en mayor proporción su espasticidad a los tres meses (OR 1,04; IC 95% 1,03-1,05). En el caso de no tener en cuenta el índice motor, las variables relacionadas con la evolución de la espasticidad fueron: edad < 75 años (OR 0,52; IC 95% 0,30-0,90), alteración sensitiva (OR 0,66; IC 95% 0,37-1,20) e índice de Barthel (OR 1,02; IC 95% 1,01-1,03). No se encontró la existencia de relación significativa para las variables sexo, mecanismo fisiopatológico (isquémico/hemorrágico), localización del ictus, presencia de afasia o deterioro cognitivo. CONCLUSIONES: La prevalencia de espasticidad en pacientes que han sufrido un ictus es del 54,8% al tercer mes de evolución. El índice motor al ingreso es predictor independiente de espasticidad a los tres meses de evolución. Los pacientes menores de 75 años, con alteración sensitiva y bajo índice de Barthel tienen más probabilidad de empeorar la espasticidad a los tres meses

OBJECTIVE: Approximately one third of patients who have suffered a stroke develop spasticity. Since clinical observations that spasticity in the elderly population is lower after stroke, and disagreement about risk factors between different authors, an analysis is performed on the variables that influence the development of spasticity. The objective of the study is to determine the how many factors influence spasticity outcome, and the prevalence of spasticity in patients who have suffered a stroke and require intensive rehabilitation treatment. METHOD: A retrospective assessment was carried out on a total of 554 patients from two neurorehabilitation centres. A record was made of sociodemographic data, aetiology, type and location of stroke, motor and sensory deficits, language and swallowing impairment, incontinence, cognitive and mood state. Spasticity levels at admission and at the third month were studied in 462 patients using the Ashworth scale. Multivariate regression analyses were used to assess the risk factors for spasticity present at the third month after stroke. RESULTS: The mean age of the patients was 67.3 years, of which 67.1% were men, and with ischemic aetiology in 76.5%. On admission 31.4% of patients had spasticity, and this increased to 54.8% at the 3rd month. The absolute risk factor for spasticity was motor index (OR 1.04; 95% CI 1.03-1.05). When this factor was omitted, the variables with predictive ability were: age less than 75 years (OR 0.52; 95% CI 0.30-0.90), sensory impairment (OR 0.66; 95% CI 0.37-1.20), and lower Barthel index score (OR 1.02; 95% CI 1.01-1.03). There was no significant relationship for gender, physiopathological mechanism (ischaemic/haemorrhagic), stroke location, aphasia, or cognitive impairment. CONCLUSION: The prevalence of spasticity in stroke at third month of follow-up was 54.8%. Motor index is the independent predictor of spasticity. Patients younger than 75 years old, with sensory impairment and low Barthel index score are more likely to develop spasticity

[Stroke spasticity: Is age a risk factor? Observational study of spasticity in neurovascular patients in a retrospective series of two health sites]. / Espasticidad tras ictus: ¿la edad es un factor de riesgo? Estudio observacional de la espasticidad en pacientes neurovasculares en una serie retrospectiva de dos centros.

OBJECTIVE: Approximately one third of patients who have suffered a stroke develop spasticity. Since clinical observations that spasticity in the elderly population is lower after stroke, and disagreement about risk factors between different authors, an analysis is performed on the variables that influence the development of spasticity. The objective of the study is to determine the how many factors influence spasticity outcome, and the prevalence of spasticity in patients who have suffered a stroke and require intensive rehabilitation treatment. METHOD: A retrospective assessment was carried out on a total of 554 patients from two neurorehabilitation centres. A record was made of sociodemographic data, aetiology, type and location of stroke, motor and sensory deficits, language and swallowing impairment, incontinence, cognitive and mood state. Spasticity levels at admission and at the third month were studied in 462 patients using the Ashworth scale. Multivariate regression analyses were used to assess the risk factors for spasticity present at the third month after stroke. RESULTS: The mean age of the patients was 67.3 years, of which 67.1% were men, and with ischemic aetiology in 76.5%. On admission 31.4% of patients had spasticity, and this increased to 54.8% at the 3rd month. The absolute risk factor for spasticity was motor index (OR 1.04; 95% CI 1.03-1.05). When this factor was omitted, the variables with predictive ability were: age less than 75 years (OR 0.52; 95% CI 0.30-0.90), sensory impairment (OR 0.66; 95% CI 0.37-1.20), and lower Barthel index score (OR 1.02; 95% CI 1.01-1.03). There was no significant relationship for gender, physiopathological mechanism (ischaemic/haemorrhagic), stroke location, aphasia, or cognitive impairment. CONCLUSION: The prevalence of spasticity in stroke at third month of follow-up was 54.8%. Motor index is the independent predictor of spasticity. Patients younger than 75 years old, with sensory impairment and low Barthel index score are more likely to develop spasticity.

Fuerza prensil del anciano frágil encamado. Estudio longitudinal observacional / Hand grip of frail bedridden elderly. Observational longitudinal study

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Uso compasivo de cannabidiol en espray para el tratamiento de paraparesia espástica en un paciente con adrenomieloneuropatía / Compassionate use of cannabidiol in spray form for the treatment of spastic paraparesis in a patient with adrenomyeloneuropathy

No disponible