Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? - 14/07/19
Abstract |
Objective |
To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment.
Methods |
Expert opinion based on scientific evidence and personal experience.
Results |
Botulinum toxin type A can decrease muscle tone in different types of spastic muscle overactivity, which allows for treating a large variety of spastic patterns with several etiologies. The toxin effect is sometimes insufficient to improve functional outcome and is transient, thereby requiring repeated injections. Selective neurotomy is a permanent surgical treatment of the reflex component of the spastic muscle overactivity (spasticity) that is effective for spastic equinovarus foot. The neurotomy provides a greater and more constant reduction in spasticity. However, the long-lasting effect on the non-reflex muscle overactivity, especially dystonia, is doubted. The effectiveness, clinical indications, advantages, side effects and limitations of both techniques are discussed.
Conclusion |
Botulinum toxin type A has the highest level of evidence and the largest range of indications. However, the botulinum toxin effect is reversible and seems less effective, which supports a permanent surgical treatment such as selective neurotomy, especially for the spastic foot. Further research is needed to compare the effect of botulinum toxin type A and selective neurotomy for the different types of spastic muscle overactivity and clinical patterns.
Le texte complet de cet article est disponible en PDF.Keywords : Hemiplegia, Muscle spasticity, Motor nerve block, Neurotomy, Equinovarus foot
Plan
Vol 62 - N° 4
P. 220-224 - juillet 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.