Resumen

Introduction: PSN is a microsurgical partial section of motor branches whose aim is supress the monosinaptic tonic stretching reflex leading to reduction of harmful spasticity without excessive paresis, restoring the tonic agonist-antagonist balance in a limb segment. Aims: Assess the benefits of PSN for treatment of disabling spasticity in children and teenager population. Method: 19 consecutive patients (68% males, age 5-23), were treated through PSN. 10 patients had SEF or SHA, and 9 had SHW. The inclusion criteria were age of 4 years or more; focused disabling spasticity at least grade 2 in Ashworth Mod. Scale; failure of previous non-surgical therapies; duration of spasticity more than 2 years, positive response to the motor anaesthetic block test; no evidence of irreductible muscle contracture. The goals of surgery were to improve function, cosmetics and confort of the affected limb segment. linical evaluation of spasticity (Ashworth Modified Scale), articular mobility (Goniometry), Gait (Video and gait analysis), and Prehension ( unctional 440 pts. Scale), were performed. Results: The postoperative follow-up period range from 1 to 18 months. Spasticity was reduced in all the muscles denervated. The triceps surae spasticity reduction in SE patients remain stable over a follow-up period of 6-18 months. 7/9 SE patients improved ankle active dorsiflexion, ½ SHA improved hip abduction, while a mean improvement of 31.3° in wrist supination and 28.7° in wrist extension was achieved in the SHW group. 8/9 SE patients showed improvement in 1 or more of the following gait features: ankle dorsiflexion, length of step, gait speed, proximal kinematic segment performance. The prehension improved in 7 patients (78%). All SHW patients improved their confort and limb cosmetics. 3 patients (15%) had transient dysesthesia. Conclusion: PSN seems to be a reasonable safe and effective technique to achieve durable spasticity reduction and favorize the functional and confort neurorehabilitation goals in pediatric, teenager and young adult carefully selected patients.

Palabras clave: Disabling spasticity peripheral neurotomy spastic equinus oot gait analysis spastic hand spastic hip prehension motor block test.

2006-07-21   |   3,926 visitas   |   Evalua este artículo 0 valoraciones

Vol. 29 Núm.1. Junio 2006 Pags. Rev Chile Neuroc 2006; 29(1)