Louisiana State University, New Orleans, LA, USA.
Semin Pediatr Neurol. 2010 Dec;17(4):261-7. doi: 10.1016/j.spen.2010.10.009.
Many clinicians frequently face the dilemma of whether and how to medically treat spasticity. When pharmacologic intervention is deemed appropriate, treatment decisions must first be based on accurate assessment using valid and reliable clinical instruments, and, importantly, specific, measurable, achievable, and realistic treatment goals should be delineated. For the treatment of localized or segmental spasticity, botulinum toxin (BoNT-A) is recommended as an effective and generally safe treatment. For more generalized spasticity, a number of useful oral agents and intrathecal baclofen are available, each with their positive and negative attributes. Fundamental knowledge of pharmacologic properties and toxicities of these medications is required for safe and appropriate use. To achieve optimum results, spasticity treatment should be part of an integrated therapeutic approach in which patients, caregivers, therapists, physicians, and surgeons have an open and clear communication about the overall rehabilitation process of the patient. This review summarizes the current pharmacologic approaches to spasticity treatment in children, critically evaluating published studies in the context of established evidence-based criteria.
许多临床医生经常面临是否以及如何对痉挛进行医学治疗的困境。当认为药物干预是合适的时，治疗决策必须首先基于使用有效和可靠的临床仪器进行准确评估，并且重要的是，应明确具体、可衡量、可实现和现实的治疗目标。对于局部或节段性痉挛，肉毒毒素（BoNT-A）被推荐为有效且通常安全的治疗方法。对于更广泛的痉挛，有许多有用的口服药物和鞘内巴氯芬可供选择，每种药物都有其积极和消极的属性。为了安全和适当使用这些药物，需要了解其药理学特性和毒性的基本知识。为了达到最佳效果，痉挛治疗应该是综合治疗方法的一部分，其中患者、护理人员、治疗师、医生和外科医生就患者的整体康复过程进行开放和明确的沟通。这篇综述总结了目前治疗儿童痉挛的药物方法，根据既定的循证标准批判性地评估了已发表的研究。
