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2.
Turk J Pediatr ; 61(1): 126-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559734

RESUMO

Sik G, Aydoseli A, Çitak A. Intrathecal baclofen use in the management of tetanus related spasm: A case report. Turk J Pediatr 2019; 61: 126-129. Tetanus is an infectious disease of the central nervous system with high mortality rates characterized with respiratory distress and tonic muscle spasms. The most common cause of mortality is cardiovascular complications (40%) and respiratory distress (15%). Despite vaccination programs, tetanus remains to be a significant healthcare issue in developing nations. Prolonged sedation and administration of muscle relaxants prolongs the period on mechanical ventilation and duration of hospitalization in severe tetanus cases. However, intrathecal baclofen (ITB) therapy might shorten the duration of stay at intensive care units, improve patient outcomes, and constitute a treatment option alternative to paralytic agents and sedation. In this manuscript, we present a 12-years-old case diagnosed with tetanus and treated with ITB upon observation of spasms refractory to high dose sedation and muscle relaxants.


Assuntos
Baclofeno/uso terapêutico , Bombas de Infusão Implantáveis , Relaxantes Musculares Centrais/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Tétano/complicações , Criança , Feminino , Humanos , Infusão Espinal , Espasticidade Muscular/microbiologia , Tétano/diagnóstico
3.
J Rehabil Med ; 51(10): 813-816, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31529136

RESUMO

OBJECTIVE: To compare walking speed in patients with spastic hemiparesis who received abobotulinumtoxinA either in the lower limb or simultaneously in both the lower and upper limbs. DESIGN: Post hoc analysis from a phase 3 study of abobotulinumtoxinA (Dysport®, NCT01251367). PATIENTS: Adult patients with spastic hemiparesis causing gait dysfunction. METHODS: Comfortable barefoot walking speed over 10 m was evaluated in patients receiving lower limb vs lower and upper limb injections over ≤4 treatment cycles; 1,000 U or 1,500 U in lower limb for cycle 1/2; optional upper limb injections from cycle 3 (500 U: upper limb, 1,000 U: lower limb). RESULTS: Mean (standard deviation; SD) lower limb cycle 3/4 doses were lower in the lower plus upper limb group vs lower limb only (1,000 U (SD 50), 1,000 U (SD 50) vs 1,380 U (SD 210), 1,360 U (SD 220). Baseline comfortable barefoot walking speed was similar between groups. Changes at cycle 3 week 4, in m/s, were: lower and upper limb: +0.063 (SD 0.131); lower limb only: +0.078 (SD 0.114), and cycle 4 week 4: lower and upper limb: +0.086 (SD 0.166); lower limb only: +0.086 (SD 0.123). CONCLUSION: Simultaneous lower and upper limb abobotulinumtoxinA treatment does not hamper improvement in walking speed compared with lower limb treatment alone. Thus, physicians may split the 1,500 U abobotulinumtoxinA dose as needed to best treat patients with spastic paresis.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Lesões Encefálicas/complicações , Espasticidade Muscular , Paresia , Acidente Vascular Cerebral/complicações , Caminhada/fisiologia , Adulto , Humanos , Extremidade Inferior/fisiologia , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Paresia/tratamento farmacológico , Paresia/fisiopatologia , Extremidade Superior/fisiologia
4.
BMC Neurol ; 19(1): 222, 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31493784

RESUMO

BACKGROUND: Treatment of spasticity poses a major challenge in amyotrophic lateral sclerosis (ALS) patient management. Delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) oromucosal spray (THC:CBD), approved for the treatment of spasticity in multiple sclerosis, serves as a complementary off-label treatment option in ALS-related spasticity. However, few structured data are available on THC:CBD in the treatment of spasticity in ALS. METHOD: A retrospective mono-centric cohort study was realised in 32 patients that meet the following criteria: 1) diagnosis of ALS, 2) ALS-related spasticity; 3) treatment with THC:CBD. Spasticity was rated using the Numeric Rating Scale (NRS). Patient's experience with THC:CBD was assessed using the net promoter score (NPS) and treatment satisfaction questionnaire for medication (TSMQ-9) as captured through telephone survey or online assessment. RESULTS: The mean dose THC:CBD were 5.5 daily actuations (range < 1 to 20). Three subgroups of patients were identified: 1) high-dose daily use (≥ 7 daily actuations, 34%, n = 11), 2) low-dose daily use (< 7 daily actuations, 50%, n = 16), 3) infrequent use (< 1 daily actuation, 16%, n = 5). Overall NPS was + 4.9 (values above 0 express a positive recommendation to fellow patients). Remarkably, patients with moderate to severe spasticity (NRS ≥ 4) reported a high recommendation rate (NPS: + 29) in contrast to patients with mild spasticity (NRS < 4; NPS: - 44). For the three main domains of TSQM-9 high mean satisfaction levels were found (maximum value 100): effectiveness 70.5 (±22.3), convenience 76.6 (±23.3) and global satisfaction 75.0 (±24.7). CONCLUSION: THC:CBD is used in a wide dose range suggesting that the drug was applied on the basis of individual patients' needs and preferences. Contributing to this notion, moderate to severe spasticity was associated with an elevated number of daily THC:CBD actuations and stronger recommendation rate (NPS) as compared to patients with mild spasticity. Overall, treatment satisfaction (TSQM-9) was high. The results suggest that THC:CBD may serve as a valuable addition in the spectrum of symptomatic therapy in ALS. However, prospective studies and head-to-head comparisons to other spasticity medications are of interest to further explore the effectiveness of THC:CBD in the management of spasticity, and other ALS-related symptoms.


Assuntos
Esclerose Amiotrófica Lateral/tratamento farmacológico , Canabidiol/administração & dosagem , Dronabinol/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Adulto , Idoso , Esclerose Amiotrófica Lateral/complicações , Estudos de Coortes , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos
5.
Rev. neurol. (Ed. impr.) ; 69(5): 199-206, 1 sept., 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184457

RESUMO

Objetivo. Evaluar la efectividad de la toxina botulínica en el tratamiento de la espasticidad de los miembros superiores e inferiores en pacientes pediátricos en un entorno clínico real. Pacientes y métodos. Se realizó un estudio retrospectivo basado en el historial clínico de 79 pacientes pediátricos con espasticidad en diferentes formas clínicas y grados de afectación tratados con toxina botulínica tipo A. La mejoría de la rigidez y movilidad fue estimada por el médico tratante mediante exploración física, evaluando la marcha, la calificación en la escala de Ashworth y la medición de los ángulos de movilidad articular mediante un goniómetro. Se registró el número de inyecciones, el intervalo entre ellas, el sitio de aplicación y la dosis, y se consideró una respuesta positiva al tratamiento la disminución del al menos un punto en la escala de Ashworth o un incremento en los grados de movilidad articular. Resultados. Los pacientes recibieron inyecciones en 10 ± 7 músculos diferentes en intervalos de 4 a 50 semanas (media: 13 ± 9 semanas). Un 90% de los pacientes recibió rehabilitación. Las articulaciones de la rodilla, el tobillo y la muñeca presentaron un mayor porcentaje de mejoría. En el 24% de los pacientes se encontró mejoría en los grados de movimiento articular. Conclusión. La aplicación de toxina botulínica tipo A fue efectiva para el tratamiento de la espasticidad en la población pediátrica


Aim. To evaluate the effectiveness of botulinum toxin in the treatment of upper and lower limb spasticity in pediatric patients in a real clinical setting. Patients and methods. A retrospective study was conducted based on information from clinical records of 79 pediatric patients with spasticity in different clinical forms and severity treated with botulinum toxin type A. The improvement of rigidity and mobility was estimated by the attending physician through physical examination, evaluating the gait, rating on the Ashworth scale and measurement of joint mobility angles using a goniometer. The number of injections, the interval between them, the site of application and the dose were recorded, considering the reduction of at least one point on the Ashworth scale or an increase in the degrees of joint mobility as treatment response. Results. Patients received injections in a mean of 10 ± 7 muscles at intervals of 4 to 50 weeks (average: 13 ± 9 weeks). A 90% also received rehabilitation. The knee, ankle and wrist showed presented a higher percentage of improvement. An improvement in the degrees of movement was found in 24% of patients. Conclusion. The application of botulinum toxin type A was effective for the treatment of spasticity in the pediatric population


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Resultado do Tratamento , Estudos Retrospectivos
6.
J Clin Neurosci ; 68: 33-38, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31400999

RESUMO

Intrathecal baclofen infusion trial is a sophisticated tool for selecting patients for permanent intra thecal baclofen infusion therapy We report our clinical experience of fifteen patients with refractory spasticity who underwent a continuous ITB trial using a temporary intraspinal indwelling catheter prior to permanent pump implantation. Patients underwent placement of a temporary intrathecal catheter that was connected to an external pump. Multisource feedback was obtained from the various healthcare professionals involved (Staff Nurse, Specialist nurse, physiotherapist, Doctor, family members, patient) regarding progress of test over 48-72 h. Average Modified Ashworth score after the trial was less than 2. Some degree of dose related minor adverse events (AEs) occurred in 8 patients, with the most common being nausea, constipation, urinary retention and hypotension. 10 patients received pump implant. 5 patients did not receive a pump because of AEs or because the goals were not met. 1 patient had pump removed after 4 years because of infection.


Assuntos
Baclofeno/administração & dosagem , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Seleção de Pacientes , Idoso , Baclofeno/efeitos adversos , Cateteres de Demora , Feminino , Humanos , Bombas de Infusão Implantáveis , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Estudos Retrospectivos
7.
NeuroRehabilitation ; 45(1): 67-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403954

RESUMO

BACKGROUND: There are limited evidence of instrumented measures of gait and balance to determine the functional effects of botulinum toxin injections (BoNT-A) in spasticity after stroke. OBJECTIVE: To evaluate the functional changes in gait and balance following upper limb and lower limb BoNT-A in persons with stroke. METHODS: A pre-post prospective study of 35 stroke patients with upper and/or lower limb spasticity after focal treatment with BoNT-A. Assessments were at baseline (T0), 6-weeks (T1) and 12-weeks (T2), using validated subjective and objective physical activity measures. RESULTS: After BoNT-A injections, significant improvements in most measures of impairments, activity and participation domains were found at T1 (p < 0.05, effect sizes (r) = 0.5-0.9). There was a significant increase in low intensity physical activity (at T1) and sedentary time reductions at both follow-up periods. Instrumented gait/balance measures showed a significant increase in cadence and turn velocity, but no changes in sway measures were found using posturography. Improvements in most outcome measures were maintained at 12-weeks. CONCLUSION: BONT-A improved scores in most clinical measures but only in some of the objective gait/balance and physical activity measures. Further robust studies should utilize a larger sample size to better determine the benefits of BoNT-A for stroke-related spasticity.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Marcha , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Acidente Vascular Cerebral/complicações , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Exercício , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/administração & dosagem , Extremidade Superior/fisiopatologia
8.
Expert Rev Med Devices ; 16(9): 835-840, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393179

RESUMO

Background: Patients with multiple sclerosis spasticity (MSS) and upper limb/hand impairment who are taking 9-delta-tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (Sativex®) may have difficulty self-administering their medication, possibly limiting adherence and treatment effectiveness. A Class I EU device is available to support the administration of THC:CBD spray. Pre-production testing was undertaken in a patient sample. Methods: Current users of THC:CBD spray were recruited to review the instruction leaflet and test the device. Patients and observing health-care professionals (HCP) completed a purpose-designed questionnaire which captured user experience and HCP opinion. Results: Fifteen patients participated. Mean treatment time with THC:CBD spray was 4 (range: 0.1-6.1) years. 87% of participants 'always', 'often' or 'sometimes' had hand impairment, and 53% reported difficulty administering THC:CBD spray. Participants reported better application using the device (73%), with less strength required (54%). Most participants (93%) considered the instruction leaflet to be clear and many (66%) expressed interest in using the device. Most HCPs (93%) did not foresee any difficulties in use of the device. Conclusion: The proposed adherence device was useful to address self-application difficulties with THC:CBD spray in our sample. Providing the device to MSS patients with upper limb/hand spasticity impairment may restore autonomy and support adherence to THC:CBD spray.


Assuntos
Canabidiol/administração & dosagem , Canabidiol/uso terapêutico , Dronabinol/administração & dosagem , Mucosa Bucal/efeitos dos fármacos , Espasticidade Muscular/tratamento farmacológico , Sprays Orais , Adulto , Idoso , Canabidiol/farmacologia , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
Orv Hetil ; 160(28): 1105-1111, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31280598

RESUMO

Introduction: Botulinum toxin is used for decreasing spasticity, improving gait pattern and preventing secondary deformities and orthopedic surgeries in children with cerebral palsy. Despite its wide use, there is no evidence for the long-term beneficial effect of the toxin. Aim: The authors focused on the short-term effects of the toxin and on the subjective evaluation done by the parents about the botox treatment. Method: First, the calf muscle of 18 children was treated and casting was also performed. In our second patient group, multilevel lower limb injection was done in 12 cases. Joints' range of motion, muscle tone and spasticity were assessed before and 4-6 weeks after treatment. In ambulatory children, gait analysis was done. Side effects were recorded and parental opinion about the treatment was requested. Results: Increased ankle range of motion and decreased muscle tone and spasticity were seen in our first patient group. In the second group, hip flexion contracture became milder and hip abduction and the popliteal angle improved. However, gait analysis results only slightly changed after botox treatment. Occasional mild and transient adverse effects were observed during the pharmacologically active period of the toxin. Associate beneficial effects were also reported such as better comfort, easier movements, improving function of the non-injected upper limb, decreasing dysarthria and dysphagia. Conclusion: Our study strengthens the observation that botox treatment of the spastic calf muscle together with plaster casting can result in improved ankle dorsiflexion. Multilevel botox treatment can improve lower limb joints range of motion, however, gait pattern remains unchanged. The administration of botulinum toxin with respect to the guidelines has no major adverse effects. Further studies are needed to clarify the observed beneficial associate effects of the toxin. Orv Hetil. 2019; 160(28): 1105-1111.


Assuntos
Toxinas Botulínicas Tipo A , Paralisia Cerebral , Espasticidade Muscular , Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/tratamento farmacológico , Criança , Humanos , Extremidade Inferior , Espasticidade Muscular/tratamento farmacológico , Amplitude de Movimento Articular , Resultado do Tratamento
10.
A A Pract ; 13(1): 31-33, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260413

RESUMO

Spasticity can be very debilitating and painful. We present a case of severe spasticity from primary lateral sclerosis refractory to intrathecal baclofen in doses up to 1100 µg/d. Baclofen was weaned down and switched to intrathecal ziconotide at 0.6 µg/d. The dose was then titrated up to 3 µg/d with excellent control of spasticity. This case suggests that low-dose intrathecal ziconotide should be considered in patients with lower extremity spasticity refractory to intrathecal baclofen.


Assuntos
Doença dos Neurônios Motores/complicações , Espasticidade Muscular/tratamento farmacológico , Dor/tratamento farmacológico , ômega-Conotoxinas/administração & dosagem , Adulto , Baclofeno/uso terapêutico , Feminino , Humanos , Injeções Espinhais , Doença dos Neurônios Motores/tratamento farmacológico , Espasticidade Muscular/etiologia , Dor/etiologia , Resultado do Tratamento , ômega-Conotoxinas/uso terapêutico
11.
Ann Phys Rehabil Med ; 62(4): 252-264, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202956

RESUMO

INTRODUCTION: Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking. METHOD: Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society. RESULTS: No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine - up to 2mg/kg - "check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician"; for ropivacaine - up to 1.5mg/kg, with a maximum of 100mg - the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician. CONCLUSION: These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings.


Assuntos
Espasticidade Muscular/tratamento farmacológico , Bloqueio Nervoso/métodos , Medicina Física e Reabilitação/métodos , Anestesiologia/educação , Anestésicos Locais/efeitos adversos , Anestésicos Locais/farmacocinética , Anestésicos Locais/uso terapêutico , Contraindicações de Medicamentos , Contraindicações de Procedimentos , França , Humanos , Neurônios Motores , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/normas , Dor Processual/etiologia , Dor Processual/prevenção & controle , Medicina Física e Reabilitação/educação , Ultrassonografia de Intervenção
12.
Ann Phys Rehabil Med ; 62(4): 214-219, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31228593

RESUMO

BACKGROUND: Botulinum toxin type A (BoNT-A) injection is an effective treatment for lower-limb spasticity and should be offered as first-line treatment for focal manifestations. Although its possible role has been hypothesized, the efficacy of electrical stimulation (ES) of antagonists of the injected muscles for improving clinical outcome after BoNT-A injection remains to be established. OBJECTIVES: This randomized single-blind pilot study aimed to investigate the efficacy of ES of antagonist muscles as adjunct treatment after BoNT-A injection to plantar flexor muscles in hemiplegic patients with spastic equinus foot. METHODS: After BoNT-A injection at triceps surae, patients were randomly allocated to 2 groups: group 1, single ES session on injected muscles plus 5 sessions of ES on antagonist muscles, and group 2, single ES session on injected muscles alone. Both groups underwent daily physical therapy for 60min for 2 weeks (5 days/week). Assessments were performed before treatment (T0) and at 10 days (T1), 20 days (T2), and 90 days (T3) after treatment. Our primary outcome was gait velocity at a comfortable speed at T2 (10-m walk test [10MWT]). The following were secondary outcomes: triceps surae spasticity (Modified Ashworth Scale), ankle passive range of motion (pROM), strength of tibialis anterior muscle, and 2-min walk test (2MWT). RESULTS: The 30 patients enrolled were randomly allocated to the 2 groups: 15 in group 1 and 15 in group 2. At T1, T2 and T3, both groups showed a significant reduction in muscle tone and an increase in ankle pROM (P<0.05). At T2 and T3, both groups showed a significant increase in 10MWT and 2MWT. The groups did not significantly differ in tibialis anterior strength or primary or secondary outcome measures. CONCLUSIONS: ES of antagonist muscles does not improve clinical outcomes in the post-stroke spastic equinus foot after BoNT-A injection.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Terapia por Estimulação Elétrica , Pé Equino/terapia , Espasticidade Muscular/terapia , Fármacos Neuromusculares/uso terapêutico , Idoso , Terapia Combinada , Pé Equino/tratamento farmacológico , Pé Equino/etiologia , Feminino , Hemiplegia/tratamento farmacológico , Hemiplegia/etiologia , Hemiplegia/terapia , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Resistência Física , Projetos Piloto , Recuperação de Função Fisiológica , Método Simples-Cego , Acidente Vascular Cerebral , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento
13.
Gait Posture ; 72: 195-201, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31228856

RESUMO

BACKGROUND: Stiff Knee Gait (SKG) in stroke patients is typically treated by the inhibition of the rectus femoris (RF) with botulinum toxin (BoNT) after clinical evaluation, obtaining an average pooled recovery in knee flexion (KF) of 7 degrees. PURPOSE: Our hypothesis is that this limited recovery after BoNT could depend on the inadequacy in the selection of patients to be treated. The aim of this study was to assess the percentage of inappropriate treatments (PIT) that can be avoided when instrumental gait analysis (GA) is used, and to estimate the associated cost savings. METHODS: We retrospectively analyzed GA data from chronic stroke patients with SKG and clinically assessed knee extensors spasticity referred to our laboratory over a five-year period. Gait kinematics and dynamic electromyography data were used. Patients were considered unsuitable for RF inhibition when: their SKG was determined by inadequate ankle push-off (APO) rather than by a brake from knee extensors, based on a previously published algorithm using gait kinematics (PITKIN); when RF was not active during KF (PITEMG); and when a proximal braking mechanism was found, if this was not due to RF activity (PITGA). RESULTS: 160 patients, age 20-87 years, gait speed 9-77%height/s, KF peak -4-44 degrees, were included. Of these, in 119 cases poor APO was the main cause of SKG, thus leading to PITKIN = 74%. In 48 out of 107 non-obese subjects, RF spasticity was not involved in SKG, resulting in PITEMG = 45%. Finally, patients with a braking activity as the main cause and concurrent RF activity were 20/107 = 19%, resulting in PITGA = 81% SIGNIFICANCE: When treating SKG, proper use of GA can reduce the percentage of inappropriate treatments by BoNT at the RF up to 81%. Savings are in the order of €100k/year when considering centers treating 100 or more patients/year.


Assuntos
Transtornos Neurológicos da Marcha/terapia , Marcha , Articulação do Joelho/fisiopatologia , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Toxinas Botulínicas/uso terapêutico , Análise Custo-Benefício , Eletromiografia , Feminino , Transtornos Neurológicos da Marcha/economia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/tratamento farmacológico , Músculo Quadríceps , Estudos Retrospectivos , Procedimentos Desnecessários/economia , Adulto Jovem
14.
Ann Phys Rehabil Med ; 62(4): 207-213, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31229700

RESUMO

BACKGROUND: Botuloscope is a cohort study supported by a French public grant and aiming to evaluate a 1-year treatment of the post-stroke spastic upper limb with botulinum toxin type A (BoNT-A) in terms of individual satisfaction with respect to personalized goals and quality of life. METHODS: This was an open-label prospective, multicentric study (11 French centres) that followed 330 adults [mean (SD) age 53.7 (13.7) years] over 1 year; participants had ranked 5 therapeutic goals at inclusion [mean (SD) 5.1 (7.3) years post-stroke], had severe hemiparesis [median motricity index (MI) 40 (Q1-Q3 24 to 60)], and were assessed at inclusion (M0) and at month 3 (M3) and M12. Outcome criteria were: spasticity, range of motion, pain [visual analog scale (VAS)], motor function [Modified Ashworth Scale (MAS)] and activities (MI; Frenchay Arm Test), and overall satisfaction with the achievement of each goal (VAS) and quality of life (Reintegration to Normal Life Index). Criteria at M0 and M12 were compared. Adverse effects were also collected, as were medication changes. RESULTS: The primary goal was comfort and activities for 63% of participants and motor function for 36%. Participants underwent a mean of 2.4 injection sessions, 19% causing adverse effects. The greatest spasticity attenuation occurred with wrist flexors (median decrease in MAS -2 [Q1-Q3; -2 to -1], P<10-3). Fewer individuals took oral anti-spastic drugs (56% at M12 vs 50% at M0; P<10-2). Range of motion increased by 16°, on average (13 to 19; P<10-3) for wrist extension. Pain prevalence decreases at rest (29% at M0 vs. 19% at M12; P<10-4) and during mobilization (64% vs. 43%; P<10-4), and fewer participants took analgesics (25% vs. 17%; P<10-3). Satisfaction was high for the goals "hand hygiene" and "pain release" and moderate for "improvement in upper limb function". However, function was more improved for participants who selected this goal as the first priority than others (P<10-2). Overall, 22% had the goal "improving gait and balance", which was reasonably achieved at M12. Quality of life improved markedly [median 8 (4 to 11) vs. 6 (3 to 10); P<10-4]. Prevalence of complete dissatisfaction with the first objective was 10% to 15%. CONCLUSION: This is the first long-term follow-up of BoNT-A treatment for upper limb spasticity involving a large cohort independent of industry. Quality of life was improved by treating upper limb spasticity with BoNT-A, even at 5 years post-stroke. Personalizing objectives of the treatment amplified its efficacy. BoNT-A was a powerful analgesic when pain was spasticity-related. Treating the spastic upper limb also improved balance and gait abilities.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Braço , Toxinas Botulínicas Tipo A/administração & dosagem , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/terapia , Fármacos Neuromusculares/administração & dosagem , Planejamento de Assistência ao Paciente , Estudos Prospectivos , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Adulto Jovem
15.
Tokai J Exp Clin Med ; 44(2): 34-39, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31250424

RESUMO

OBJECTIVE: Post-stroke hemiplegic patients with a spastic clenched fist deformity that was caused by upper motor neuron syndrome often have problems with hygiene and nursing. Botulinum toxin-A (BTX-A) had been given for treatment of such patients to relieve spasticity by targeting finger joint muscles, such as the flexor digitorum superficialis and flexor digitorum profundus. However, some of these patients do not have satisfactory outcomes. Therefore, we aimed to examine the clinical efficacy and outcome of BTX-A treatment that targeted the upper lumbrical muscles (ULM) in patients with spastic clenched fist deformity caused by stoke. METHODS: Chronic stroke patients with spastic clenched fist deformity who received BTX-A treatment were evaluated retrospectively. We obtained data from medical records before and at 4 weeks after BTX-A injection to the ULM. The clinical data and outcome measures analyzed included range of motion, the Modified Ashworth Scale, the numeric graphic rating scale for pain, and 2 items from the disability assessment scale (ease of cleaning palm and trimming nail). RESULTS: Wilcoxon signed rank test showed that BTX-A treatment significantly improved all measures. CONCLUSION: BTX-A therapy to the ULM provided satisfactory outcomes in improving spastic clenched fist.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Articulações dos Dedos , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Músculo Esquelético , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Doença dos Neurônios Motores/etiologia , Espasticidade Muscular/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
16.
J Med Syst ; 43(8): 238, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31214849

RESUMO

Nowadays, one of the choice techniques for the spasticity treatment is the ultrasound-guided infiltration of Botulinum Toxin, because it is safe and effective. In order to medical professionals can carry out this technique, they need training and education. One of the safest and most time-free ways to facilitate the acquisition of practical medical skills is through simulators. In this paper we present an innovative technological environment, which includes an ultrasound simulator for training in muscle exploration and infiltration. The simulation platform will guide health professionals, with great realism and high degree of interactivity, in the autonomous training of all the tasks involved in the spasticity treatment procedure by infiltration of Botulinum Toxin, without the need for a real patient or costly phantoms.


Assuntos
Toxinas Botulínicas/administração & dosagem , Pessoal de Saúde/educação , Espasticidade Muscular/tratamento farmacológico , Sistema Musculoesquelético , Software , Simulação por Computador , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia/métodos
17.
BMC Neurol ; 19(1): 96, 2019 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-31078139

RESUMO

BACKGROUND: Post-stroke lower limb spasticity (PSLLS) has a prevalence of 28-37%. PSLLS can cause difficulty in walking and reduce quality of life (QOL). Post stroke spasticity impairs the ability to intervene to improve walking ability. Botulinum Toxin A (BT) is an effective intervention for focal spasticity, but its use is currently restricted in many countries by their reimbursement system stating that the evidence for improvement in walking and quality of life (QOL) is not robust for treatment in the lower limb. This randomized control trial (RCT) will investigate the effectiveness of BT in modifying spasticity, and improving functioning (mobility, walking, activities of daily living (ADL's) and QOL. METHODS/DESIGN: A double-blind placebo-controlled trial injection will assess the effect of BT compared with a placebo (normal saline) in a sample of n = 94 patients. Following treatment of spasticity measured by Modified Ashworth Scale (MAS), the primary outcome of gait velocity will be measured by i) Gait Rite (Electronic Walkway); ii) walking by 2 Min Walk Test; iii) balance by Berg Balance Scale; mobility by iv) Timed Up and Go (TUG); v) lower limb function by ABILICO; vi) patient related goal by Goal Attainment Scale (GAS); vii) QOL by SF 12 (Rand version); viii) activities of daily living by the Functional Autonomy Measurement System (SMAF). There will be an associated health economic analysis. DISCUSSION: The study methodology is based on our systematic review 2026 studies, which concluded the evidence for improving mobility following use of BT to reduce spasticity was not robust. The results of this study could establish the use of BT in improving gait and lower limb function in PSLLS. This study could provide the evidence needed for reimbursement schemes to consider and changes to its funding policy for BT in PSLLS. TRIAL REGISTRATION: The trial is registered with the Australia New Zealand Clinical Trails Registry (ANZCTR)- ANZCTRN12617001603303 . Registered 07/12/2017.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Atividades Cotidianas , Idoso , Método Duplo-Cego , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Projetos de Pesquisa , Caminhada
18.
Tidsskr Nor Laegeforen ; 139(8)2019 May 07.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31062563

RESUMO

BACKGROUND: For more than 20 years, intramuscular injections of botulinum toxin A have been an established treatment for spasticity in children with cerebral palsy. We investigated the proportion of children with cerebral palsy who receive such treatment in Norway and the guidelines that apply to the treatment. MATERIAL AND METHOD: Data from the five-year registration in the Cerebral Palsy Registry of Norway were used to investigate the proportion of children with cerebral palsy born in the period 1999-2010 treated with botulinum toxin A, and whether there were any variations in the proportion of children treated between the habilitation centres. We conducted an online survey to identify the treatment guidelines that were applied in all of the 21 habilitation centres. RESULTS: A total of 1 414 children (average age 6.3 years) were included, of whom 775 (55 %) had been treated with botulinum toxin A. The proportion of children who received treatment varied considerably between the habilitation centres (38-80 %; p < 0.001). The maximum dose of botulinum toxin A per treatment per patient was 200-600 units of Botox. Five centres reported to have written guidelines for the treatment indication. INTERPRETATION: The proportion of children with cerebral palsy who are treated with botulinum toxin A varies considerably between Norwegian habilitation centres.


Assuntos
Toxinas Botulínicas Tipo A , Paralisia Cerebral/tratamento farmacológico , Fármacos Neuromusculares , Baclofeno/administração & dosagem , Baclofeno/uso terapêutico , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Relaxantes Musculares Centrais/administração & dosagem , Relaxantes Musculares Centrais/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/uso terapêutico , Noruega/epidemiologia , Procedimentos Ortopédicos , Guias de Prática Clínica como Assunto , Sistema de Registros , Centros de Reabilitação , Inquéritos e Questionários
19.
Biomed Res Int ; 2019: 8329306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080830

RESUMO

Background: Inconsistent data have been reported for the effectiveness of intramuscular botulinum toxin type A (BTXA) in patients with limb spasticity after stroke. This meta-analysis of available randomized controlled trials (RCTs) aimed to determine the efficacy and safety of BTXA in adult patients with upper and lower limb spasticity after stroke. Methods: An electronic search was performed to select eligible RCTs in PubMed, Embase, and the Cochrane library through December 2018. Summary standard mean differences (SMDs) and relative risk (RR) values with corresponding 95% confidence intervals (CIs) were employed to assess effectiveness and safety outcomes, respectively. Results: Twenty-seven RCTs involving a total of 2,793 patients met the inclusion criteria, including 16 and 9 trials assessing upper and lower limb spasticity cases, respectively. For upper limb spasticity, BTXA therapy significantly improved the levels of muscle tone (SMD=-0.76; 95% CI -0.97 to -0.55; P<0.001), physician global assessment (SMD=0.51; 95% CI 0.35-0.67; P<0.001), and disability assessment scale (SMD=-0.30; 95% CI -0.40 to -0.20; P<0.001), with no significant effects on active upper limb function (SMD=0.49; 95% CI -0.08 to 1.07; P=0.093) and adverse events (RR=1.18; 95% CI 0.72-1.93; P=0.509). For lower limb spasticity, BTXA therapy was associated with higher Fugl-Meyer score (SMD=5.09; 95%CI 2.16-8.01; P=0.001), but had no significant effects on muscle tone (SMD=-0.12; 95% CI -0.83 to 0.59; P=0.736), gait speed (SMD=0.06; 95% CI -0.02 to 0.15; P=0.116), and adverse events (RR=1.01; 95% CI 0.71-1.45; P=0.949). Conclusions: BTXA improves muscle tone, physician global assessment, and disability assessment scale in upper limb spasticity and increases the Fugl-Meyer score in lower limb spasticity.


Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Toxinas Botulínicas Tipo A/uso terapêutico , Extremidades/fisiopatologia , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Tono Muscular/efeitos dos fármacos , Tono Muscular/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
20.
Arch Phys Med Rehabil ; 100(5): 837-843, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030729

RESUMO

OBJECTIVE: To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation. DESIGN: Retrospective open label study. Mean duration of follow-up 64 months. SETTING: Primary-care and referral center, ambulatory and hospitalized care. PARTICIPANTS: Patients (N=116) undergoing continuous ITB trials between 2006 and 2017. INTERVENTIONS: Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump. MAIN OUTCOME MEASURES: Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events. RESULTS: A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up. CONCLUSIONS: Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events.


Assuntos
Baclofeno/administração & dosagem , Bombas de Infusão Implantáveis , Relaxantes Musculares Centrais/administração & dosagem , Espasticidade Muscular/tratamento farmacológico , Adulto , Músculos do Dorso , Baclofeno/efeitos adversos , Feminino , Marcha , Humanos , Infusão Espinal , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/efeitos adversos , Seleção de Pacientes , Equilíbrio Postural , Estudos Retrospectivos
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