Cordero-GarcÍa Carlos, SÁEnz De Tejada SÁnchez María Del Mar
Department of Physical Medicine and Rehabilitation, Juan Ramón Jiménez University Hospital, Huelva, Spain.
J Rehabil Med Clin Commun. 2021 Jun 14;4:1000065. doi: 10.2340/20030711-1000065. eCollection 2021.
To describe a case of early management of post-stroke spasticity treated with incobotulinumtoxinA (IncoA) in a patient with SARS-CoV-2 (COVID-19). Scarce information is available on this subject, as the COVID-19 pandemic has necessitated postponement of interventions in infected and clinically suspicious patients.
A 58-year-old woman presenting with ischaemic stroke, was infected with SARS-CoV-2 virus due to nosocomial contact. Despite clinical improvement, the patient developed early spasticity. Modified Ashworth Scale (MAS) was grade II in her left elbow, wrist flexors and left gastrocnemius. IncoA was injected, using ultrasound guidance, in her upper and lower limbs. No complications were reported after the procedure. Two weeks afterwards, there was an improvement in her motor balance and spasticity, MAS was graded I in the left elbow, wrist flexors, and II in the left gastrocnemius. At 12 weeks, the patient reported improvement at a global level, with increasing independence and functionality.
This case indicates the benefits and safety of IncoA for early treatment of post-stroke spasticity in a patient with confirmed SARS-CoV-2. Despite the current status of national healthcare systems due to the COVID-19 pandemic, increased efforts should be made to avoid discontinuation of treatment for spasticity.
描述1例感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2,即新型冠状病毒肺炎)患者使用incobotulinumtoxinA(IncoA)对中风后痉挛进行早期治疗的病例。关于这一主题的信息很少,因为新型冠状病毒肺炎大流行使得对感染及临床疑似患者的干预措施不得不推迟。
一名58岁女性因缺血性中风入院,因医院感染接触感染了SARS-CoV-2病毒。尽管临床症状有所改善,但患者出现了早期痉挛。改良Ashworth量表(MAS)显示其左肘部、腕屈肌和左腓肠肌为II级。在超声引导下对其上肢和下肢注射了IncoA。术后未报告并发症。两周后,其运动平衡和痉挛情况有所改善,左肘部、腕屈肌的MAS分级为I级,左腓肠肌为II级。12周时,患者报告整体情况有所改善,独立性和功能有所增强。
本病例表明IncoA对确诊感染SARS-CoV-2的患者早期治疗中风后痉挛具有益处且安全。尽管由于新型冠状病毒肺炎大流行,国家医疗系统目前处于这种状况,但仍应加大力度避免中断对痉挛的治疗。