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[神经病理学中的痉挛:病理生理机制、诊断与治疗进展的最新情况]

[Spasticity in neurological pathologies. An update on the pathophysiological mechanisms, advances in diagnosis and treatment].

作者信息

Sáinz-Pelayo M P, Albu S, Murillo N, Benito-Penalva J

机构信息

Institut de Neurorehabilitació Guttmann-UAB, 08916 Badalona, España.

出版信息

Rev Neurol. 2020 Jun 16;70(12):453-460. doi: 10.33588/rn.7012.2019474.

Abstract

INTRODUCTION

Spasticity is a frequent clinical sign in people with neurological diseases that affects mobility and causes serious complications: pain, joint limitation, muscular contractions and bed sores, which have a significant effect on the individual's functionality and quality of life.

AIM

To review the integration, description and critical interpretation of the most recent scientific evidence on the clinical variability of spasticity and associated symptoms, the different pathophysiological mechanisms and their relevance in the diagnostic and therapeutic approach.

DEVELOPMENT

A search was conducted in the scientific publications on the different aspects of spasticity grouped into two main categories: cerebral and spinal cord pathologies. The epidemiological, clinical and pathophysiological aspects, clinical and instrumental diagnoses, and the physiotherapeutic, pharmacological and surgical approach to spasticity in each group of pathologies were all reviewed.

CONCLUSION

Spasticity is related to structural lesions and maladaptive neuroplastic changes that determine an important variability in its clinical expression. Although its diagnosis presents important limitations, the use of clinical and neurophysiological diagnostic tools aimed at achieving different approaches in cases of neurological pathologies originating in the brain and in the spinal cord could optimise the effectiveness of spasticity therapies.

摘要

引言

痉挛是神经疾病患者常见的临床症状,会影响活动能力并引发严重并发症:疼痛、关节受限、肌肉收缩和褥疮,这些对个体的功能和生活质量有重大影响。

目的

综述关于痉挛临床变异性和相关症状、不同病理生理机制及其在诊断和治疗方法中的相关性的最新科学证据的整合、描述和批判性解读。

进展

在科学出版物中检索了关于痉挛不同方面的内容,分为两大类:脑和脊髓病变。对每组病变中痉挛的流行病学、临床和病理生理方面、临床和仪器诊断以及物理治疗、药物治疗和手术治疗方法进行了综述。

结论

痉挛与结构损伤和适应性不良的神经可塑性变化有关,这些变化决定了其临床表型的重要变异性。尽管其诊断存在重要局限性,但使用旨在针对源于脑和脊髓的神经疾病病例采用不同方法的临床和神经生理诊断工具,可以优化痉挛治疗的效果。

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