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CURRENT ISSUEEUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 2004 June;40(2):123-30

UPPER MOTOR NEURON SYNDROME: EVALUATION AND TREATMENT OF SPASTICITY
Guest Editor: FRANCO MOLTENI 

 REVIEWS

Selective neuromuscular blocks and chemoneurolysis in the localized treatment of spasticity

Carda S., Molteni F.

Ospedale Valduce, Villa Beretta Costamasnaga, Lecco

Selective neu­ro­mus­cu­lar ­blocks and chem­o­neu­rol­y­sis are cur­rent­ly the ­most wide­spread ther­a­pies for treat­ing local­ized or loco­re­gion­al spas­tic­ity. Both pro­ce­dures ­present advan­tag­es and dis­ad­van­tag­es. The ­main advan­tag­es of BTX-A are its rel­a­tive ­ease of use, low inci­dence of ­side ­effects, rever­sibil­ity and ele­vat­ed effi­ca­cy. Its dis­ad­van­tag­es are the lim­it­ed max­i­mum ­dose, ­which ­does not per­mit the treat­ment of ­many mus­cles simul­ta­ne­ous­ly, espe­cial­ly if ­they are ­large, and its rel­a­tive­ly ­high ­cost. Phenol neu­rol­y­sis has a low ­cost, ele­vat­ed effi­ca­cy in the con­trol of path­o­log­ic mus­cle over­ac­tiv­ity, and ­long dura­tion of ­effect. Its dis­ad­van­tag­es are the ­risk of inju­ry to the vas­cu­lar and sen­so­ry struc­tures and the dif­fi­cul­ty in per­form­ing the pro­ce­dure. The ­risks asso­ciat­ed ­with neu­rol­y­sis ­have led to an increas­ing inter­est in and use of BTX-A, mak­ing it one of the ­most wide­ly ­used ther­a­pies in treat­ing local­ized spas­tic­ity. From the per­spec­tive of a bal­anced ben­e­fit-­risk anal­y­sis, a ­viable ­option for ­some cas­es may be to com­bine phe­nol neu­rol­y­sis for treat­ing spas­tic­ity in ­large prox­i­mal mus­cles and BTX-A for treat­ing hyper­to­nia in ­small dis­tal mus­cles.

language: English


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