Hemiplejik hastalarda oral baklofen ve botulinum toksin enjeksiyonu tedavilerinin elektromyografik nosiseptif fleksör refleks üzerine etkisinin araştırılması
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Tarih
2020
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Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Spastisite, üst motor nöron lezyonlarından sonra hiperaktif reflekslerin ortaya çıkmasıyla ilişkili, pasif hareketlere karşı hıza bağımlı olarak artan bir direnç şeklinde tanımlanır (1). İnme sonrası gelişen hemipleji tablosu birçok problemi de beraberinde getirir. Spastisite de bu problemlerden biridir. Spastisite tedavisinde sistemik ilaç tedavisi (baklofen, diazepam, dantrolen ve tizanidin) veya lokal tedavi (botulinum toksini, fenol enjeksiyonu) uygulanabilir. Çalışmamızın amacı; spastisitesi olan hemiplejik hastalarda oral baklofen tedavisi ile botulinum toksin enjeksiyonu tedavilerinin elektromiyografik nosisetif fleksör refleks (NFR) eşiği üzerine etkisini araştırmaktır. Yöntem: Çalışmaya Hatay Mustafa Kemal Üniversitesi Tıp Fakültesi Araştırma ve Uygulama Hastanesi Fiziksel Tıp ve Rehabilitasyon polikliniğine başvuran, spastik hemipleji tanılı, 18-65 yaş arası toplam 29 hasta alındı. Hastalar randomize edilerek bir gruba botulinum toksin enjeksiyonu tedavisi, diğer gruba oral baklofen tedavisi verildi. Her iki grup tedavi başlangıcında ve 6. hafta tedavi bitiminde değerlendirildi. Hastaların modifiye ashworth skalası (MAS), vizüel analog skala (VAS) değerleri, brunnstrom evrelemesi, barthel günlük yaşam aktivite indeksi ve NFR eşik değerleri ile değerlendirme yapıldı. Bulgular: Spastik hemiplejik hastalarda BT-A ve baklofen alan her iki grupta MAS, VAS değerleri tedavi öncesine göre anlamlı azaldı (p<0.05). Ayak bileği MAS değeri BT-A alanlarda baklofen alanlardan daha fazla düşüş gösterdi (p<0.05). BT-A grubunda tedavinin 6. haftasında brunnstrom el evrelemesinde anlamlı artış saptandı (p<0.05). Baklofen grubunda NFR eşiği tedavi öncesine kıyasla istatiksel olarak anlamlı yükseldi (p=0.007). BT-A grubunda NFR eşiğinde istatiksel olarak anlamlı değişim görülmedi (p=0.669). Sonuç: Bu çalışma hemiplejik hastalarda spastisite tedavisi için verilen BT-A ve baklofenin iyileşmeye önemli katkılar sağladığını gösterdi. Baklofen NFR eşiğinde anlamlı yükselmeye neden olabilirken BT-A uygulamasının bu eşiği pek değiştirmediği söylenebilir.
Objective: Spasticity is defined as an increased rate-dependent resistance to passive movements related to the occurrence of hyperactive reflexes after upper motor neuron lesions (1). The hemiplegia chart after apoplexy brings out many problems. Spasticity is one of these problems. Systemic medicine therapy (baclofen, diazepam, dantrolene and tizanidine) or local therapy (botulinum toxin, phenol injection) can be used in the treatment of spasticity. The aim of our study; to investigate the effect of oral baclofen and botulinum toxin injections on electromyographic nociceptive flexor reflex (NFR) threshold in hemiplegic patients with spasticity. Methods: 29 spastic hemiplegia patients who applied to the Physical Medicine and Rehabilitation outpatient clinic of Hatay Mustafa Kemal University Medical Faculty Research and Application Hospital participated in the study. After the patients had been randomized a group of them were applied a treatment of botulinum toxin injection, but the other group a treatment of to oral baclofen. Both groups were evaluated at the beginning and at the end of the 6th week treatment. The evaluation was performed according to the patients' modified ashworth scale (MAS), visual analog scale (VAS), brunnstrom staging, barthel daily life activity index and NFR threshold values. Results: MAS, VAS values decreased significantly compared to pretreatment (p<0.05) in spastic hemiplegic patients who accepted BT-A and baclofen in both groups. Ankle MAS values were observed significantly lower in BT-A patients than in baclofen patients (p<0.05). Brunnstrom hand staging was significantly increased at the 6th week of treatment (p<0.05) in the BT-A group. The NFR threshold was significantly higher in the baclofen group compared to pretreatment (p=0.007). There was no statistically significant change in NFR threshold in the BT-A group (p=0.669). Conclusion: This study showed that BT-A and baclofen applied for the treatment in spastic hemiplegic patients made significant contributions to healing. While baclofen can cause a significant increase in the NFR threshold, it can be said that BT-A administration does not change this threshold much.
Objective: Spasticity is defined as an increased rate-dependent resistance to passive movements related to the occurrence of hyperactive reflexes after upper motor neuron lesions (1). The hemiplegia chart after apoplexy brings out many problems. Spasticity is one of these problems. Systemic medicine therapy (baclofen, diazepam, dantrolene and tizanidine) or local therapy (botulinum toxin, phenol injection) can be used in the treatment of spasticity. The aim of our study; to investigate the effect of oral baclofen and botulinum toxin injections on electromyographic nociceptive flexor reflex (NFR) threshold in hemiplegic patients with spasticity. Methods: 29 spastic hemiplegia patients who applied to the Physical Medicine and Rehabilitation outpatient clinic of Hatay Mustafa Kemal University Medical Faculty Research and Application Hospital participated in the study. After the patients had been randomized a group of them were applied a treatment of botulinum toxin injection, but the other group a treatment of to oral baclofen. Both groups were evaluated at the beginning and at the end of the 6th week treatment. The evaluation was performed according to the patients' modified ashworth scale (MAS), visual analog scale (VAS), brunnstrom staging, barthel daily life activity index and NFR threshold values. Results: MAS, VAS values decreased significantly compared to pretreatment (p<0.05) in spastic hemiplegic patients who accepted BT-A and baclofen in both groups. Ankle MAS values were observed significantly lower in BT-A patients than in baclofen patients (p<0.05). Brunnstrom hand staging was significantly increased at the 6th week of treatment (p<0.05) in the BT-A group. The NFR threshold was significantly higher in the baclofen group compared to pretreatment (p=0.007). There was no statistically significant change in NFR threshold in the BT-A group (p=0.669). Conclusion: This study showed that BT-A and baclofen applied for the treatment in spastic hemiplegic patients made significant contributions to healing. While baclofen can cause a significant increase in the NFR threshold, it can be said that BT-A administration does not change this threshold much.
Açıklama
Anahtar Kelimeler
Fiziksel Tıp ve Rehabilitasyon, Physical Medicine and Rehabilitation, Hemipleji, spastisite, nosiseptif fleksör refleks, botulinum toksin-A, baklofen, Hemiplegia, spasticity, nociceptive flexor reflex, botulinum toxin-A, baclofen
