Cervical dystonia is a syndrome characterized by anomalous postures and unintentional repetitive movements of the head and the neck. Aim of this study is to show the effectiveness of the combined treatment botulinum toxin-FKT through the use of a recent methodic of investigation, myoton, and of the classical clinical evaluations, such as Tsui and VASscales. 15 patients (9 females, 6 males) have been selected. During the initial visit and in the following controls, performed every month, patients have been submitted to physiatric examination, clinical evaluation of the dystonia through the Tsui scale, clinical evaluation of the pain through the VAS scale, myometric evaluation. We obtained statistically reduction of muscular tone's value in passive elongation (to=16,34±1,23) until 4 month (t4 =16,1l±1,23), when we performed a second infiltration. After 4 months from the second infiltration (t8=15,99±1,1l) value did not present more some statistical correlation and was necessary to perform a new infiltration. Values of elasticity, stiffness, Tsui and VASscale followed the same course ofthe tone. Our study demonstrates that combined treatment botulinum toxin-FKT is effective. It emerges that if to the treatment with botulinum toxin follows a suitable FKT treatment, the effect of the drug lasts 4 months and not 3 months as described by the literature. Our study has underlined that using myometric measurement we can consider least changes in muscular tone, elasticity and stiffness; we have a broader view of the spastic muscle, and we can better plan appropriate rehabilitative care for each patient.Cervical dystonia is a syndrome characterized by anomalous postures and unintentional repetitive movements of the head and the neck. It develops through:1. contemporary contraction of agonist and antagonists muscles; 2. reduction of the motor control inhibiting mechanisms; 3. alteration of the afferences from basal ganglia Pl. In relationship to the posture of the head and the neck four types of cervical dystonia are recognized: torticollis (head and neck are rotated in hourly sense or counterclockwise), 1aterocollis (head tilted on the shoulder), retrocollis (turned head to the back with the nape toward the shoulders) or anterocollis (turned head in ahead with the chin toward the sternum). It is often associated with other types of diystonia (oro-mandibular, blepharospasm, axial or hand dystonia) and / or postural tremor. Symptoms increase by the work, the stress and the motor activity; they decrease by the postural changes and the rest. From different years, therapy with botulinum toxin has radically modified the functional prognosis ofthe cervical dystonia; it become the first-quality treatment [2]. The effectiveness of the treatment is tied up to the correct identification of the muscles and the suitable dosing of toxin to inject. The identification of the muscles depends on the posture of the head and neck. Torticollis is mainly sustained by the contralateral sternocleidomastoid muscle (SCM) and ipsilateral splenius m...
This provisional PDF corresponds to the article as it appeared upon acceptance.A copyedited and fully formatted version will be made available soon. The final version may contain major or minor changes.Subscription: Information about subscribing to Minerva Medica journals is online at: http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissionssend an email to: journals.dept@minervamedica.it -journals2.dept@minervamedica.it -2 1. ABSTRACT Background. Hemiplegia is the most common form of Cerebral Palsy. Upper Limb is generally more affected than lower one. In fact, hemiplegic children can spontaneously acquire standing and walking ability, while manipulation remains uncertain, with severe limitations in activity and participation, which define child's functional status (International Classification of Functioning -ICF). Several non-surgical tools are currently available to approach upper limb impairments. Studies regarding upper limb multilevel surgery in Hemiplegic Cerebral Palsy are relatively few and inhomogeneous.Aim. The aim of this study is to propose a surgical approach based on upper limb functional level and manipulation strategy and establish whether multilevel surgery can improve segmental alignment, performance and capacity, that ICF defines as activities and participation qualifiers.Design. This study is an observational retrospective study.Setting. This study involves patients who referred to Children Rehabilitation Unit of IRCCS S. Maria Nuova in Reggio Emilia (Italy), along a period of four years. Population. It involves children affected by hemiplegic cerebral palsy who underwent upper limb multilevel surgery. Method. For each patient, we previously defined functional use of affected upper limb applying the House classification and the Ferrari one of manipulation pattern. Patients are divided into three groups: synergic hand (House 4, 5), imprisoned hand (House 3), excluded hand (House 0). We recorded goals achievement through Goal Attainment Scale and unimanual and bimanual abilities through Melbourne Assessment of Unilateral Upper Limb Function and through Assisting Hand Assessment respectively. Results. We record 16 upper limb multilevel surgical interventions in 13 children and report their results.Conclusion. This study suggests that surgery can induce a segmental and/or aesthetic and/or a functional change depending on manipulation pattern. It also underlines the importance to analyse results in term of spontaneous manipulation abilities and daily use.Clinical rehabilitation impact. This study provides a preliminary guide to plan surgery in relation to segmental deformities and overall manipulation pattern and describes their feasible improvement measures. It also suggests the most useful tools to record goal achievements in modifying manipulation function. COPYRIGHT© EDIZIONI MINERVA MEDICAThis document is
A new preparation of botulinum toxin type A called NT 201, free from complexing proteins, potentially with low antigenicity has been used in the therapy of spasticity in stroke patients. This was an open-label study reported the safety and the efficacy of one-year treatment with NT 201 evaluating the therapeutic effect on functional disability and on quality of life in upper limb spasticity after stroke. Patients received a botulinum toxin therapy in the upper injected intramuscularly. After inoculation, patients were submitted to a motor rehabilitation program for upper limb injected three times/week. Re-treatment was permitted at 12 weeks after the prior treatment. Safety assessment included evaluation of adverse events and efficacy was measured by Modified Ashworth Scale for spasticity (MAS), Spasm Frequency Score (SFS) for the daily spasms, and Disability Assessment Scale (DAS) for disability. Of 35 consecutive patients (13 women and 12 men) screened for study eligibility, 20 (6 women and 14 men) patients (mean age 63,4±7,03) were included in this study and were submitted to NT 201 therapy for one year. At the baseline, botulinum toxin dose in the upper limb ranged from 160 to 450U, whereas total dose in the last treatment administrated was reduced respect the first injections ranging from 120 to 350U. All the enrolled patients completed the year-long study and reported an improvement of clinical picture. MAS, was statistically (p<0,001) reduced in all muscles at T1 (mean score ±SD: 2.65±0.67) and T2 (mean score ±SD: 2.55±0.60) in comparison to the baseline T0 (mean score ±SD: 3.9±0.78). Significant reduction (p<0,001) from baseline T0 (mean score ±SD: 3.25± 0.78) was also noted in SFS at T1 (mean score ±SD: 1.55±0.51) and T2 (mean score ±SD: 1.30±0.47). The DAS score showed a reduction of the T1score (mean score ±SD: 1.70±0.47) and T2 score (mean score ±SD: 1,40±0,50) respect to baseline T0 score (mean score ±SD: 2,65±0,48) statistically significant (p<0,001). No adverse effects were observed in these patients. NT 201 appeared to be an efficacious and well-tolerated long-term treatment option for patients with upper limb spasticity after stroke, obtaining a substantial improvement in functional disability, muscle hypertone, and daily spasms.
The word dysphagy was suggested by Nicolatopoulos (1907) and derives from the ancient Greek “δυς”, which means “difficulty” and “καταπινειν”, which means “to swallow”. Generally, the dysphagy is defined on the basis of its origin: oral, pharynx and oesophagus, otherwise by its mechanical or neurological aetiology. The symptoms are dependent on the nature of the lesions in the affected organs. The swallow is a complex motor sequence dependent on the coordinate contraction of the muscle of mouth, of larynx and of the oesophagus. The mechanical action of the swallow helps the liquid or solid food progression from mouth to stomach thanks to cooperation of 31 muscles and 5 cranial nerves and allows swallowing about 580 times approximately. The dysphagy in neurological diseases is mainly due to the following reasons. Increase of vascular cerebro-disease, increase of population's age and increase of road and work traumas. The difficulties in swallowing causes heavy social problems like meager diet, social isolation and worsening of quality of life. The speech rehabilitation requires the involvement of care givers through a re-educational program that takes place in two periods: the first of relaxation, and the second of restoration of phonodeglutition praxis.
Baclofen is now used in treatment of patients with severe spasticity secondary to neurological diseases throuth the direct infusion of drug into the subarachnoid space with an implanted programmable pump. Among patients whose quality of life improved after the use of intrathecal systems, a very important role belongs to people with multiple sclerosis (MS): a disease that due to a great variety of symptoms and signs, seriously affects the activities of daily living. Among the clinical manifestations of MS are also found mental health problems including depression mood. The drugs most commonly offered, for treatment of depression in patients with MS, are selective serotonin reuptake inhibitors (SSRIs), reuptake inhibitors of serotonin and norepinephrine (SNRIs) and tricyclic antidepressants (TCA). Duloxetine presents a high affinity for transporters reuptake of serotonin and noradrenalin, and exerts its activity on both molecules. In addiction, Duloxetine has demonstrated very effective in treatment of depressive disorders of mood as demonstrated by scientific evidences about the utility of Duloxetine in the modulation of painful physical symptoms associated with depression and in treatment of pain associated with diabetic neuropathy. The purpose of our study is to evaluate the effects of antidepressant therapy with duloxetine, 60 mg/day in 7 patients with multiple sclerosis treated with intrathecal baclofen for spastic modulation of tone. The experience we gained, according to data from several multicenter trials confirmed the efficacy of Baclofen intrathecally administered, especially as regards modulation spasticity. Our study also showed, although the limitations of a sample still small, a good clinical response to combined treatment Baclofen intrathecal/duloxetine 60 mg/day.
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