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2014, Número 2

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Rev Mex Med Fis Rehab 2014; 26 (2)


Consenso Nacional del Sistema de Centros de Rehabilitación Infantil Teletón (SCRIT) México en el uso de toxina botulínica tipo A para el manejo de espasticidad y otras alteraciones neuromusculoesqueléticas en niños

Idioma: Español
Referencias bibliográficas: 120
Paginas: 45-65
Archivo PDF: 337.99 Kb.


RESUMEN

Introducción: Los Centros de Rehabilitación Infantil Teletón (CRIT’s) son unidades de cuidados multidisciplinarios de rehabilitación en las que los niños con discapacidad neuromusculoesquelética son atendidos desde la etapa de recién nacido hasta los 18 años de edad. Hasta el momento hay 21 CRIT’s distribuidos en México, de los cuales 16 han participado en las diferentes etapas de preparación de este documento. El objetivo de este estudio fue establecer el consenso para el manejo de 4 problemas neurológicos en los que se justifica el uso de la toxina botulínica tipo A (BoNT-A): a) espasticidad de las extremidades superiores, b) espasticidad de las extremidades inferiores, c) distonías y d) sialorrea. Metodología: Bajo la coordinación del área médica del Sistema de Centros de Rehabilitación Infantil Teletón (SCRIT), se llevó a cabo de enero a junio de 2010, la selección y formación de un grupo médico, creando un panel de revisión del proyecto de investigación para definir los temas a revisar. Más tarde, se convocó al grupo a participar en el desarrollo de un consenso. Finalmente, los expertos participantes se reunieron con el grupo, que también fue asistido por un consultor. Se armó un panel de discusión con expertos reconocidos internacionalmente que no pertenecen al Sistema CRIT (Philippe Marque, Pascual Pascual, Mauricio Delgado), quienes validaron los conceptos en el consenso; el CRIT y un sistema experto (Zorrilla Sánchez); con el fin de elaborar recomendaciones sobre el manejo de la toxina botulínica tipo A (BoNT-A) en el tratamiento de niños atendidos en el sistema CRIT, principalmente en los cuatro temas seleccionados. Conclusiones: Para la administración exitosa de la toxina botulínica tipo A (BoNT-A), se recomienda considerar los siguientes factores: selección adecuada de los pacientes, edad del niño y necesidad de aplicar un tratamiento combinado (terapia física, terapia ocupacional y otras ayudas terapéuticas); de acuerdo con esto, se debe aplicar la dosis de toxina botulínica tipo A (BoNT-A) recomendada, estableciendo objetivos y metas con el equipo interdisciplinario en conjunto con las expectativas de la familia y del paciente. Sumado a esto, es fundamental el uso adecuado de las escalas de tratamiento, tanto para el diagnóstico como para la evaluación de los beneficios.


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