Manejo de espasticidad en miembros superiores con infiltraciones de fenol y toxina botulínica

Abstract

Introduction: spasticity is a frequent complication in the lesions of the cortico-spinal system. It should treated when produce discapacity. The local infiltration of either Botulinum toxin or phenol blocks the neuro-muscular conduction by different ways and they are part of the treatment used to reduce it. Their combined use, which is hihereto found in the literature, is described. Case presentaction: male adolescent with spastic tetraparesia associated to perinatal hypoxia, who presents marked alterations in his upper extremities, flexing actitude, score 3 in the modified Ashworth scale, and reduction in the amplitude of the articular mobility (AAM). Procedure: there were infiltrations with phenol in arms and forearms, and with Botulinum toxin in the wrists and hands, without any complications. Results: there was a decrease in the spasticity of the infiltrated musculature, with increase of the AAM, mainly in elbows and fingers, this meaning a better life quality for the patient. Discussion: the neurolisis with phenol is not longer used in the developed countries due to the possible neuropathic pain as a complication, and also due to the entry to the market of the Botulinum toxin which produces lesser and less frequent collateral effects. The high cost of the Botulinum toxin is the reason why in our countries still persists the use of phenol, which is very cheap and with adequate administration gives good results. Conclusion: The combined use of Botulinum toxin type A and phenol is a good alternative to decrease spasticity and improve the quality of life of the patients who suffer it.