Title : Refractory Spasticity - New paradigms and approaches for treatment
Abstract:
Refractory Spasticity is a harmful and disabling condition, caused by upper motor lesions of different aetiologies, producing with time motor dysfunction, skeletal deformities, muscle atrophy, etc, which has poor options of treatment hence basic and clinical research is being conducted.
The goal for its treatment is to reduce the number of abnormal volley’s impulses being carried by the nervous system.
Surgical procedures as Drezectomies, Peripheral neurotomies, selective rhizotomy are currently employed but as destructive methods they are irreversible and the indications have to be pondered with their potential complications.
Functional therapies are extensively headed by chemical treatment through intrathecal baclofen infusion pump, but this method has advantages and inconveniences, it is difficult to manage, requiring trained staff and not all patients are candidates.
Functional Neurosurgery like Spinal Cord Stimulation (SCS) or Deep Brain Stimulation (DBS) are often effective but in limited number of cases.
In our unit we are conducting several clinical trials, two of them to treat Spastic Cerebral Palsy
The methods are through Lateral Cord Stimulation (LCS), and they are based on our previous research, one non-invasive through external cervical Magnetic Stimulation (clinicaltrials .gov NCT03676439), and another invasive one through spinal cervical electrode implant (clinicaltrials .gov NCT0219915), to be made if therapeutical results on the previous trial were significant. A third test is ongoing through Peripheral Magnetic Stimulation (PMS, to complete results of Selective Peripheral Neurotomy in cases of Spasticity post - stroke (clinicaltrials .gov NCT02226432).
Neural blockade is a promising method, focused on reducing the amount of neuro-muscular impulses or through an electrical blockage of the peripheral nerves of the affected areas.
It is a method under investigation at present, and could be applied as the necessary electrical parameters are mastered and the applicable electrode configurations are developed
Audience Take Away:
After the conference delegates will increase their understanding of the real magnitude of this harmful condition, the present possibilities of treatment and they will have an update about the different research work what is being conducted in the present days to improve this disabling and poorly treated disease.
For clinicians will be important be aware when they must to send their patient´s to specialists, avoiding nihilistic attitudes
