Guía de práctica clínica para el tratamiento de la espasticidad espinal con toxina botulínica

Treatment of spasticity in spinal cord injury with botulinum toxin

“…42 The other series located had fewer than 6 patients, 43,44 while the remaining papers discussed isolated clinical cases. 45-,52 The guideline used by us 13 includes a protocol covering all the evaluations that should be performed, both prior to and/or at the time of injection, as well as subsequently to assess results at 1, 3 and 6 months. However, completing the full series of medical visits often proved to be unfeasible because our hospital is a SCI referral center, and so many patients have to travel from some distance away and cannot attend as frequently as might be desirable.…”

“…12 In SCI, spasticity is characterized by predominant involvement of the phasic components of muscle stretch reflex, and by being diffuse or generalized, with its most frequent manifestation being extensor spasms of the lower extremities. 5,6,13 Factors have been described that can increase the intensity or exacerbate the symptomatology of phasic spasticity, particularly neurogenic bowel dysfunction, bladder hyper-reflexia, anxiety, supine position and transfers. 14 Spasticity seems to be more prevalent in complete SCI, yet greater interference with activities of daily living, higher levels of pain, and more functional problems are classically described in incomplete SCI, 7,15 so that these patients may in fact report worse satisfaction with their lives because of spasticity rather than the injury as such, no matter how severe the latter might be.…”

“…Muscle location was preferentially anatomic, though electric stimulation was occasionally used in deep or small muscles. Total doses were distributed by reference to patients' spastic patterns, in accordance with our recently published clinical practice guideline 13. Whereas total doses of onabotulinum and incobotulinum ranged from 30-600 units and doses per muscle ranged from 15-200 units, total doses of abobotulinum ranged from 250-1750 units and doses per muscle ranged 50-700 units.…”

Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury

“…The likelihood of diffusion appears to increase with a higher total dose per muscle. If we are treating spasticity and the diffusion occurs to a synergistic muscle to the target, we could achieve a synergistic effect, but if the diffusion occurs to a different muscle, it would be a real adverse effect because we could weaken a muscle that had no problems previously [ 46 ].…”

“…Interactions. If the toxin is administered at the same time as anticholinergics or neuromuscular blocking agents, there may be a multiplier effect, such as an overdose, and if it is administered together with aminoglycosides, there is a competition for the cleavage of SNAP-25 that can lead to the loss of effect of any of them [ 46 ].…”