Spasticity following spinal cord injury.
Spasticity following spinal cord injury.
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DOI：
10.4045/tidsskr.10.0872
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发表时间：
2012-04-30
期刊：
影响因子：
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通讯作者：
Gronning, Marit
中科院分区：
文献类型：
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作者：
Rekand, Tiina;Hagen, Ellen Merete;Gronning, Marit
背景：高达70%的脊髓损伤患者出现痉挛。本文的主要目的是提供一个概述痉挛管理，主要是在脊髓injuries.METHOD患者：文章是基于文献检索PubMed使用的关键词痉挛和痉挛和脊髓injury，和自己的临床经验和research.RESULTS：痉挛可能是一般的，区域或局部。膀胱过度充盈、梗阻、急性感染、脊髓损伤或骨折等因素可能会严重影响痉挛的程度，必须加以确定。在治疗前，对患者的临床和功能后果进行评估是决定性的。积极锻炼、物理治疗和口服药物是最简单和最便宜的选择。巴氯芬是唯一在挪威注册的中枢作用痉挛药，是口服治疗的首选。也可以使用苯并二氮杂卓。片剂的效果通常是有限的，并且通常有明显的副作用。局部痉挛可以用肉毒杆菌毒素注射治疗。效果是有时间限制的，必须重复治疗。国际指南推荐肉毒杆菌毒素注射和物理治疗相结合。在局部痉挛的情况下，特别是在下肢，通过可编程泵鞘内注射巴氯芬可提供持续的痉挛减轻效果。矫形手术或神经外科手术可能是一个选择，为选定的顽固性spasstication.Interpretation患者：痉挛后脊髓损伤必须定期评估。治疗策略取决于痉挛引起的功能衰竭的程度及其部位。
BACKGROUND: Up to 70% of patients with spinal cord injuries develop spasticity. The main aim of the paper is to provide an overview of spasticity management, primarily in patients with spinal cord injuries.METHOD: The article is based on literature searches in PubMed using the keyphrases spasticity and spasticity AND spinal cord injury, and own clinical experience and research.RESULTS: Spasticity may be general, regional or localised. Factors such as an over-filled bladder, obstipation, acute infections, syringomyelia or bone fractures may substantially influence the degree of spasticity and must be determined. An assessment of the clinical and functional consequences for the patient is decisive before management. Active exercise, physiotherapy and peroral drugs are the simplest and cheapest options. Baclofen is the only centrally acting spasmolytic registered in Norway and is the first choice for peroral treatment. Benzodiazepines can also be used. The effect of the tablets is generally limited and there are often pronounced side effects. Local spasticity can be treated with botulinum toxin injections. The effect is time-limited and the treatment must be repeated. International guidelines recommend a combination of botulinum toxin injections and physiotherapy. In cases of regional spasticity, particularly in the lower limbs, intrathecal baclofen administered via a programmable pump may provide a continuous spasm-reducing effect. Orthopaedic surgery or neurosurgery may be an option for selected patients with intractable spasticity.INTERPRETATION: Spasticity following a spinal cord injury must be assessed regularly. The treatment strategy depends on the degree of functional failure caused by the spasticity and its location.