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Infiltrate botulinum toxin

optimized ultrasound-guided

spasticity benefits

Using Botulinum toxin (BT) for the treatment of spasticity has the highest level of scientific evidence and clinical, but its benefits can be further increased if infiltration is performed using modern resources such as ultrasound guidance. This was one of the main conclusions obtained in the Fourth Day Update on Botulinum Toxin and Rehabilitation (Reabox 2011), held in Seville, organized by Allergan with the support of the English Society of Physical and Rehabilitation Medicine (SERMEF). About a hundred rehabilitation physicians gathered at this event, which benefited from contributions of Dr. Franco Molteni, an international reference in employment of modern rehabilitation techniques, based on the use of robotics and Web 2.0 resources. In addition, this meeting was also held two workshops, aimed at improving both the muscle with ultrasound localization as infiltration of botulinum toxin guided by this technique. This is the first line of a large group of English in rehabilitative ultrasound. And, as noted by Dr. Lluís Girao, Chief of Physical Medicine and Rehabilitation Hospital of Mataró (Barcelona), "the proper administration of TB within the target muscles to be treated depends largely achieve the greatest therapeutic effect and minimize side effects. " In fact, the expert said, "lack of response to treatment with this drug in selected patients is mainly related to errors in target muscle location (more errors at greater depths and smaller muscle) and the spread of TB to unselected muscles. " Improve results: a possible target As evidenced in this forum, a concept that persists in daily practice is to assess the use of techniques to guide the infiltration of TB according to the depth of the target muscle. Thus, we distinguish between muscle groups infiltrating surface (visible and accessible), which does not require additional means to locate the muscle and deep muscle infiltration or small thickness, which recommended an additional means to ensure muscle location TB is deposited in the target muscle. In recent years there have been many studies and literature reviews supporting the use of certain techniques to guide the injections. "The choice of technique to use should be based on the characteristics of the patient, the characteristics of the target muscle, the scientific evidence available and the skills of responsible management," said Dr. Guirao. Among the different methods of muscle location for the administration of botulinum toxin can opt for infiltration guide anatomical or palpation, electromyography, electrical stimulation and ultrasound. With this last resort, according to Dr. Lluís Guirao said, there are also significant benefits, since "it is a safe technique, allows control over the depth of injection, facilitates viewing and control of adjacent structures and prevent infiltration of unwanted places. " He added, "allows dynamic scans, reduces complications (such as hematomas) and can be used simultaneously with other techniques location. " also the president of SERMEF, Inmaculada García Montes, highlighted another advantage of ultrasound, "and it is a tool available in most hospitals." In his opinion, "Ultrasound is a painless imaging technique that is useful for guiding interventional procedures such as infiltration of TB, remains a reliable tool to analyze real-time targeted muscle, adjacent structures and to monitor progress of the needle into the tissue. " In his view, "the infiltration TB guided by ultrasound is a technique that allows us to treat more muscle and better, more effective (providing greater functionality to the patient) and profitable. " respect to costs arising from this type of intervention, the president of SERMEF made clear that "the infiltration of TB in patients with a clear indication of direct and indirect costs cheaper, since, among other things, reduces rehabilitation sessions, in most cases will not produce clinical efficacy so obvious that using this drug. " Botulinum toxin and spasticity Spasticity is a medical problem of high incidence and significance both in childhood (associated with cerebral palsy) and adulthood (mainly resulting from stroke). Spain is estimated that 10 of every 1,000 people have spasticity, it is estimated that between 300,000 and 400,000 people suffer from this condition. Among other changes, spasticity can cause developmental disorders in children, decreased functional capacity, abnormal postures, pain, and aesthetic and hygienic conditions. Its natural evolution tends to become chronic, static phenomena accompanied by soft tissue alterations. In addition, significantly affects the quality of life of patients and their families. Spasticity is a symptom that reflects a motor disorder of the nervous system in which certain muscles are permanently contracted. This contraction causes stiffness and shortening of muscles and interferes with its various movements and functions: walking, handling, balance, speech, swallowing, etc. Treatment of spasticity is complex and requires a multidisciplinary intervention. The fundamental basis is combination therapy, which should include treatment with physical therapy. In the last decade, focal spasticity has been treated with botulinum toxin type A. The implementation of this treatment has shown, among other benefits, which can significantly improve the quality of life of spastic patients, reducing severe consequences arising from prolonged abnormal postures, as that the development of joint deformities due to muscle contractions.