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Revista Oficial de la Universidad Biomédica Rafael Guízar y Valencia A. C.

2007, Número 1-2

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Plasticidad y Restauración Neurológica 2007; 6 (1-2)


Manejo de la espasticidad en el niño con toxina botulínica tipo A 500 unidades. Consenso Querétaro

Hernández SJ, Chio MCSMV, Arteaga RÁ, Pascual PI, Gómez HFJ, Mendoza WLS, Zorrilla J, Aguilar RF

Idioma: Español
Referencias bibliográficas: 60
Paginas: 63-75
Archivo PDF: 220.88 Kb.


RESUMEN

Objetivos. La introducción de toxina botulínica tipo A (TBA) en el tratamiento de la espasticidad en los niños y adultos constituyó un gran avance en la neurología clínica para pacientes niños y adultos. Actualmente es considerada como el primer tratamiento de la espasticidad focal. Métodos. En un intento por lograr la optimización de este recurso terapéutico, especialmente en México donde la toxina botulínica todavía es desconocida en algunos estados, se han elaborado diferentes pautas clínicas en las que se revisa la evidencia disponible sobre la indicación y el uso de TBA. La espasticidad se caracteriza por la presencia de hiperactividad muscular involuntaria que se asocia a menudo a dolor, espasmos, deformidad e invalidez funcional. Resultados. Del punto de vista clínico, las ventajas de TBA son obvias (la facilidad de su uso y determinación de la dosificación, larga duración del efecto, reversibilidad en caso de una respuesta inadecuada, reordenamiento del cálculo de la dosis cuando por alguna razón no se hizo correctamente, respuesta inapropiada, posibilidades para rectificar y nueva aplicación, etc.) y sin duda su beneficio supera ampliamente sus desventajas. Para su empleo adecuado se requiere de una selección apropiada de pacientes, de objetivos terapéuticos claros y del conocimiento de las áreas musculares a ser tratadas, y en suma se requiere de un programa hecho a la medida para cada paciente en cuanto a la aplicación del medicamento y al programa de rehabilitación personalizada. La experiencia sugiere que la administración temprana será más eficaz para evitar o prevenir las complicaciones de la espasticidad. Conclusiones. TBA es eficaz en el tratamiento de la espasticidad y desempeña un papel significativo si los objetivos clínicos son funcionabilidad y reorganización neuroanatómica. La experiencia actual está bien documentada sobre su uso e indicaciones, así como su seguridad y efectos colaterales, además del beneficio en generar nuevos patrones motores cerebrales basados en la plasticidad neuronal.


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