Espasticidad

Abstract

La espasticidad es un desorden motor que hace parte del síndrome de motoneurona superior y se caracteriza por un incremento dependiente de la velocidad del reflejo tónico de estiramiento o de tono muscular; se acompaña de reflejos miotendinosos exagerados e hiperexcitabilidad del reflejo de estiramiento. Es muy frecuente en pacientes con síndrome de motoneurona superior secundario a diversas patologías como ataque cerebrovascular, lesiones medulares, esclerosis múltiple y parálisis cerebral. Un abordaje multidisciplinario e individualizado es fundamental en el tratamiento de los pacientes; e incluye como pilares el manejo no farmacológico, farmacológico, neuroquirúrgico y ortopédico. El presente trabajo pretende realizar una revisión no sistematizada pero actualizada sobre la historia, epidemiología, fisiopatología, abordaje diagnóstico y terapéutico de la espasticidad, tanto en la población adulta como en la pediátrica; así como plantear un algoritmo terapéutico.

Effect of Botulinum Toxin Injections in the Treatment of Spasticity of Different Etiologies: An Umbrella Review

“…Spasticity is a highly prevalent neurological sequelae that significantly affects quality of life. It manifests as an intrinsic increase in muscle resistance related to the speed of the tonic reflex during passive stretching of a limb in individuals with upper motor neuron syndrome [ 1 ] ( Figure 1 ). Spasticity leads to complications such as pain, a distorted joint position, postural and hygiene difficulties, joint contractures, and permanent deformities [ 2 ].…”

“…Spasticity leads to complications such as pain, a distorted joint position, postural and hygiene difficulties, joint contractures, and permanent deformities [ 2 ]. It is common in patients with central nervous system disorders such as stroke, multiple sclerosis, spinal cord injuries [ 3 ], traumatic brain injuries, and cerebral palsy (CP) [ 1 ]. Approximately 12 million people worldwide are estimated to suffer from spasticity [ 4 ].…”

“…There are two scales used specifically to assess spasticity. The first is the Modified Ashworth Scale (MAS) [ 1 , 3 ], an ordinal scale that measures the intensity of muscle tone on a scale of 0 to 4 [ 3 ]. On this scale, 0 represents “no increase in tone,” while 4 indicates that the limb is “stiff in flexion or extension” [ 5 ] ( Supplementary Table S1 ).…”

“…On this scale, 0 represents “no increase in tone,” while 4 indicates that the limb is “stiff in flexion or extension” [ 5 ] ( Supplementary Table S1 ). The second is the Tardieu Scale or the Modified Tardieu Scale [ 1 , 3 ], which is also an ordinal scale that assesses the intensity of resistance to muscle stretch [ 3 ]. According to the Modified Tardieu Scale, each muscle group is rated for a specific stretching speed according to two parameters.…”

“…The treatment of spasticity requires a multidisciplinary team, which includes medical specialists, occupational therapists, physiotherapists, nurses, and nutritionists, among others, to achieve the best results and improve patient quality of life [ 1 ]. There is evidence of the efficacy of different treatments for the improvement in spasticity, such as physiotherapy (stretching, use of orthoses, cryotherapy, heat, etc.…”