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Abstract(s)
A espasticidade corresponde a um estado de hipertonicidade e hiperreflexia e que faz parte
da síndrome do neurónio motor superior. Pode ser devida a qualquer lesão no sistema
nervoso central (por exemplo, acidente vascular cerebral, esclerose múltipla, traumatismo
cranioencefálico, entre outros) da qual resulta um desequilíbrio entre os impulsos
inibitórios e excitatórios e uma dissociação entre as entradas aferentes e a resposta motora.
A clínica da espasticidade varia consoante a lesão, podendo afetar um membro ou um
segmento (lesão no córtex cerebral) ou estar distribuída de forma mais generalizada
(patologias mistas ou que afetem somente a medula espinhal). Caso não seja detetada e
tratada precocemente os pacientes podem desenvolver contraturas que levam a
deformidades fixas das extremidades, incompatíveis com o movimento.
Para além do exame físico completo (incluindo um exame neurológico detalhado), é
necessário ter em conta diversas escalas qualitativas de avaliação da espasticidade, testes
instrumentais ou quantitativos, medidas relatadas pelos pacientes e métodos que avaliam a
qualidade de vida.
Antes de iniciar qualquer tratamento é necessário eliminar possíveis fatores agravantes
associados, como a dor, assim como delinear objetivos realistas que estão de acordo com a
condição do paciente. É importante uma abordagem multidisciplinar, sendo que as terapias
não farmacológicas, como exercício, fisioterapia e órteses, são a base do tratamento, apesar
de ainda se poderem adicionar outras terapias instrumentadas. Caso essa abordagem não
farmacológica não seja suficiente para aliviar a sintomatologia do doente, podemos ainda
acrescentar terapias farmacológicas sistémicas (baclofeno oral ou intratecal, tizanidina,
diazepam, dantroleno, gabapentina, clonidina ou nabiximol) ou locais (injeções de toxina
botulínica, álcool ou fenol). Em último caso, podemos optar ainda pela terapiacirúrgica.
Spasticity corresponds to a state of hypertonicity and hyperreflexia and is part of the upper motor neuron syndrome. It can be due to any lesion in the central nervous system (e.g., stroke, multiple sclerosis, traumatic brain injury, among others) resulting in an imbalance between inhibitory and excitatory impulses and a dissociation between afferent inputs and motor response. The spasticity clinic varies depending on the injury, affecting a limb or a segment (cerebral cortex injury) or being distributed in a more generalized way (mixed pathologies or those affecting only the spinal cord). If not detected and treated early, patients may develop contractures that lead to fixed deformities of the extremities, incompatible with movement. In addition to a complete physical examination (including a detailed neurological examination), various qualitative spasticity assessment scales, instrumental or quantitative tests, patient-reported outcomes and methods that assess quality of life must be taken into account. Before starting any treatment, it is necessary to eliminate possible associated aggravating factors, such as pain, as well as outline realistic goals that are in line with the patient's condition. A multidisciplinary approach is important, with non-pharmacological therapies such as exercise, physiotherapy and orthoses being the basis of treatment, although other instrumented therapies can still be added. If this non-pharmacological approach is not sufficient to alleviate the patient's symptoms, we can also add systemic pharmacological therapies (oral or intrathecal baclofen, tizanidine, diazepam, dantrolene, gabapentin, clonidine or nabiximol) or local ones (botulinum toxin, alcohol or phenol injections). In the last case, we can also opt for surgical therapy.
Spasticity corresponds to a state of hypertonicity and hyperreflexia and is part of the upper motor neuron syndrome. It can be due to any lesion in the central nervous system (e.g., stroke, multiple sclerosis, traumatic brain injury, among others) resulting in an imbalance between inhibitory and excitatory impulses and a dissociation between afferent inputs and motor response. The spasticity clinic varies depending on the injury, affecting a limb or a segment (cerebral cortex injury) or being distributed in a more generalized way (mixed pathologies or those affecting only the spinal cord). If not detected and treated early, patients may develop contractures that lead to fixed deformities of the extremities, incompatible with movement. In addition to a complete physical examination (including a detailed neurological examination), various qualitative spasticity assessment scales, instrumental or quantitative tests, patient-reported outcomes and methods that assess quality of life must be taken into account. Before starting any treatment, it is necessary to eliminate possible associated aggravating factors, such as pain, as well as outline realistic goals that are in line with the patient's condition. A multidisciplinary approach is important, with non-pharmacological therapies such as exercise, physiotherapy and orthoses being the basis of treatment, although other instrumented therapies can still be added. If this non-pharmacological approach is not sufficient to alleviate the patient's symptoms, we can also add systemic pharmacological therapies (oral or intrathecal baclofen, tizanidine, diazepam, dantrolene, gabapentin, clonidine or nabiximol) or local ones (botulinum toxin, alcohol or phenol injections). In the last case, we can also opt for surgical therapy.
Description
Keywords
Diagnóstico Espasticidade Fisiopatologia Nabiximol Tratamento