Salud Preventiva:Uso de toxina botulínica en manejo de espasticidad

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La toxina botulínica se ha convertido en la primera línea de tratamiento para la espasticidad focal.
Especialista en Medicina de Rehabilitación, gerencia de Medicina Física y Rehabilitación, Espasticidad y su tratamiento.
En la medicina actual contamos con múltiples patologías que producen un fenómeno llamado espasticidad. Esta no es más un aumento del tono muscular, derivado de alguna condición que afecta el sistema nervioso central y que, por definición técnica, es “velocidad dependiente”.
Esto último se refiere a que su médico, regularmente el médico rehabilitador o fisiatra, evaluará de forma estática y dinámica ese aumento del tono, buscando cuál es la respuesta de un reflejo de estiramiento que de manera patológica está alterado en los pacientes con espasticidad, generando que el músculo se torne rígido, disminuyendo así la amplitud del arco de movimiento, lo que se traduce en discapacidad asociada a sus actividades de la vida diaria, como autocuidado, alimentación e incluso actividades de ocio.

Este fenómeno se refiere solo a tono muscular y no a fuerza muscular, y es algo importante que los pacientes puedan diferenciar, ya que el tratamiento que va enfocado a mejorar la espasticidad no se traduce en una mejoría de la fuerza, aunque algunos tratamientos podrían tener un impacto negativo como efecto adverso sobre la misma.

El sistema nervioso central (SNC) está compuesto por estructuras complejas y especializadas en manejar y controlar estímulos, que son regulados por fenómenos inhibitorios mediados por neurotransmisores que son alterados por condiciones que dañan el SNC. Estas alteraciones pueden producir afectación global, expresada en cuatro extremidades, o en un hemicuerpo (lado del cuerpo) o extremidad específica, dependiendo de la magnitud y ubicación del daño o lesión en el SNC.

El médico rehabilitador o fisiatra es el encargado de seguir todo el proceso de rehabilitación en pacientes con daño cerebral, incluyendo, sobre todo, el grado de discapacidad relacionada con este. Esta se mide utilizando una clasificación diseñada por la Organización Mundial de la Salud (OMS) llamada Clasificación Internacional de Funcionalidad, Discapacidad y estados relacionados con la salud (CIF), y pone en evidencia el estado actual y evolución de los aspectos de la vida diaria importantes para cada paciente que en ocasiones son dejados de lado, enfocándose el clínico solo en la enfermedad.

Esto le da una dimensión humana al enfoque de rehabilitador, logrando aunar esfuerzos y planificar para lograr la reinserción laboral y social del paciente, disminuyendo, por ejemplo, la dependencia de familiares en el aspecto económico, en la mayoría de los casos. Además logra sintonizar las expectativas del paciente con la realidad, y aquello que está al alcance.
La espasticidad se trata cuando tiene un impacto negativo en esa funcionalidad a la que nos referimos, o cuando produce dolor y limitación para la realización de sus actividades de la vida diaria.
Tenemos diferentes opciones para el tratamiento según la necesidad: medicamentos orales (relajantes musculares de acción central), y programas de rehabilitación consistentes en terapia física y ocupacional.

 

 

 

 

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Publicado por➦ YA

Fuente➦ Hoy

 

 

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