痉挛症状管理.pdf

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1、Symptom Management:SpasticityRob Gross,MDAssistant Professor,Department of NeurologyUniversity of Colorado Anschutz Medical CampusApril 6th,2024Disclosures No relevant disclosuresWhat is spasticity?Muscle tightness,stiffness,cramping,or spasmsCan lead to contractures,pain,limited range of motion,and

2、 reduced functionDue to damage to descending upper motor neuron pathwaysSeen in MS,TBI,stroke,CP,and other conditionsWhat isnt spasticity?Weakness Numbness Rigidity SeizureGrading SpasticityFactors that worsen spasticity Illness Elevated body temperature Stress Certain movements or position changes

3、Pain ConstipationMedical Treatment of Spasticity Things to do at home Physiotherapy Oral muscle relaxants Intrathecal baclofen Botox injections Rhizotomy or other surgical interventionsMild to Moderate SevereCannabinoids?TMS?Things to do at home Stretching Heat IcePhysiotherapy Physical therapy Occu

4、pational therapy Dry needling Acupuncture Electrical stimulationOral Anti-Spasticity Meds Baclofen Cyclobenzaprine Tizanidine Methocarbamol Carisoprodol Dantrolene Diazepam Gabapentin/pregabalinBaclofen Prescriptions After MS DiagnosisSmith KA,Piehl F,et al.J Neurol Neurosurg Psychiatry.2023Intrathe

5、cal Baclofen Pump implanted into abdomen Catheter delivers medicine into spinal canal Needs to be programed by provider Depending on rate,reservoir may need to be refilled every few weeks to months Disadvantages/risks:infection,withdrawal,CSF leak,eventual need to replace pumphttps:/my.clevelandclin

6、ic.org/health/treatments/8997-intrathecal-baclofen-pumpBotox InjectionsEsquenazi A,et al.PM R.2017doi:10.1016/j.pmrj.2017.02.014Spasticity Treated by Nabiximols*Chan A,Silvn CV.Neurodegener Dis Manag.2022 Oromucosal spray containing CBD and-9-THC 1:1 Sativex licensed in Europe,Canada,and elsewhere b