pharmacological and surgical procedures for the treatment of spasticity n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Pharmacological and Surgical Procedures for the Treatment of Spasticity PowerPoint Presentation
Download Presentation
Pharmacological and Surgical Procedures for the Treatment of Spasticity

Loading in 2 Seconds...

play fullscreen
1 / 48

Pharmacological and Surgical Procedures for the Treatment of Spasticity - PowerPoint PPT Presentation


  • 222 Views
  • Uploaded on

Pharmacological and Surgical Procedures for the Treatment of Spasticity. Luigi Piccinini M.D., PM&R Scientific Institute «Medea» Bosisio Parini (LC) Italy. Spasticity Reduction vs Function. Spasticity = pathological factor Spasticity = tool for function

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Pharmacological and Surgical Procedures for the Treatment of Spasticity' - bonnie


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
pharmacological and surgical procedures for the treatment of spasticity

Pharmacological and SurgicalProcedures for the Treatment of Spasticity

Luigi Piccinini M.D., PM&R

ScientificInstitute «Medea»

Bosisio Parini (LC) Italy

spasticity reduction vs function
SpasticityReduction vs Function
  • Spasticity = pathologicalfactor
  • Spasticity = tool for function
  • Spasticity + MuscleWeakness
slide3

«May the force be with you» (Starwars)

  • Considermusclestrength and weakness (Piccinini)
aims of treatment
Aims of Treatment
  • Painreduction
  • Functionalimprovements
  • Facilitate use of orthosis
  • Preventsecondaryproblems (muscle & bone deformities) (Early Treatment)
  • Facilitate nursing and caring
treatment options
Treatment Options

General

SDR

Oraldrugs

ITB

Reversible

Not reversibile

BTX

Surgery

Focal

oral drugs1
OralDrugs
  • Diffusedspasticity
  • Mild/moderate Spasticity
  • Too young for otheroptions
side effects
Side Effects
  • Sedation
  • Sleepiness
  • Increasedsialorrhea
  • Excessivehypotonia
  • Hypotension
baclofen l ioresal
Baclofen (Lioresal)
  • 5 mgs/day
  • Increasedosage of 5 mgseach 3-4 days
  • Maxdosage: ???
botulinum toxin2
BotulinumToxin
  • Identifyfunctionalproblem
  • Measureit
  • Intervention
  • Outcomemeasurement
  • Maintainimprovement
botulinum toxin3
BotulinumToxin
  • Safe
  • No anaphylacticreactionsreported
  • Avoid use duringpregnancy
botulinum toxin4
BotulinumToxin
  • Botox
  • Dysport
  • Xeomin
  • ………
botulinum toxin dilution
BotulinumToxinDilution
  • 1 cc
  • 2 cc
  • 5 cc
  • ……………….
  • Reduced or increaseddiffusion
primary non responders
Primary Non- Responders
  • Musclefixedcontractures
  • Subclinicpreviousbotulism
  • USA Armyimmunization
secondary non responders
Secondary Non-Responders
  • Antibodies in 5-10% pts
adverse events
AdverseEvents

BoNtA Placebo

  • > Falls 9,3% 3%
  • Pain 2,3% /
  • Local weakness 2,3% /
  • General weakness 1% /
therapeutical effect
Therapeuticaleffect
  • Begins in 3-4 days
  • Maxeffect: 2-3 weeks
  • Duration: 3-6 months
action
Action

2

3

1

4

5

Adapted from: dePaiva et al.

PNAS 1999, 96:3200

repeat treatment
Repeat treatment
  • Samemuscles: 3 months
  • Differentmuscles: 1 month
until
Until………
  • Musclefixedcontracture
  • Antibodies
injection techniques
InjectionTechniques
  • Free?
  • EMG guided?
  • CT guided?
  • US guided ?
sedation
Sedation
  • Midazolam?
  • EMLA?
  • Spray Ice?
  • ???
combined therapies
CombinedTherapies
  • BoNtA + PT
  • BoNtA + orthosis
  • BoNtA + casting /serial casting
casting serial casting
Casting / Serial Casting
  • 1 week afterinjection
  • Removeafter 2 weeks
  • Possible re-casting with increaseddorsiflexion
  • Afterremoving, orthosis + PT
results
Results
  • OxygenConsumption
  • HR
  • Endurance
  • Improvement of kinetic and kinematicparameters
itb advantages
ITB Advantages
  • Reduced side effects
  • Reducedeffective dose compared to oraldrug
  • Telemetricprogramming
itb effects
ITB: Effects
  • Improvement of ADLs
  • Improvedcompliance for PT
  • Reduce pain
  • Sleepimproving
itb management
ITB Management
  • Bolus test
  • Goodresponsepumpimplantation
  • Progressive dose increaseuntiloptimaleffect
  • Effectmonitoring
  • Refill
itb advantages1
ITB Advantages
  • High concentration in CSF
  • Reduced side effects
  • Reducedspasticityonlyduring the day
  • Increasedwalkingability
  • Increasedcomplianceduring PT
  • Reducedpain
  • Reversibility
itb disadvantages
ITB Disadvantages
  • Surgery
  • Management difficulty
  • Periodicsurgery
  • Complications
relationship orthopaedic issues spasticitytreatment
RelationshipOrthopaedicIssues/SpasticityTreatment
  • Givepriority to primaryproblems
  • Correctlaterorthopaedicdeformities
  • Youcouldavoidorthopaedicsurgery
post surgery
Post- Surgery
  • Rehabilitation Center
  • Progressive increase of drug flow (20%/day)
  • Complicationsmonitoring
  • Posturalassessment
  • Evaluation for assistivedevices and/or orthosis
  • Encourage the achievement of new motor pattern
complications
Complications
  • Infectionsremove
  • CatheterkinkingXRaysurgery
  • CathetercollapseXRaysurgery
  • Leaking
removal management
Removal Management
  • Gradual flow reduction (20%/day)
  • Oraldrugs
  • Pumpswitch-off / pumpremoval
rhyzotomy
Rhyzotomy
  • No experience in HSP (only CP)
  • Notreversible
orthopaedic surgery
OrthopaedicSurgery
  • Notspecific for spasticity
  • Secondaryproblems
aims of treatment1
Aims of Treatment
  • Rule # 1: choose

THAT treatment for

THAT spasticity in

THATpatient

gracias

Gracias!

luigi.piccinini@bp.lnf.it