medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-10-101-107medsovet-6270Research ArticleСПАСТИЧЕСКИЕ РАССТРОЙСТВАSPASTIC DISORDERSСовременные тенденции в реабилитации пациентов со спастическим парезом при очаговом поражении головного мозгаCurrent trends in the rehabilitation of patients with spastic paresis with focal brain damagehttps://orcid.org/0000-0002-2877-3094КрыловаЛ. В.KrylovaL. V.

Крылова Лариса Владимировна - заведующая отделением медицинской реабилитации пациентов с поражением центральной нервной системы.

423803, Набережные Челны, набережная Тукая, д. 39

Larisa V. Krylova, Head of the Department of Medical Rehabilitation of Patients with Central Nervous System Disorders.

39, Tukay Emb., Naberezhnye Chelny, 423803

krylova-larisa@bk.ruhttps://orcid.org/0000-0002-8825-2346ХасановаД. Р.KhasanovaD. R.

Хасанова Дина Рустемовна - доктор медицинских наук, профессор, профессор кафедры неврологии и нейрохирургии факультета повышения квалификации и профессиональной переподготовки специалистов.

Казань, 420012, Казань, ул. Бутлерова, д. 49

Dina R. Khasanova, Dr. Sci. (Med.), Professor, Professor of the Department of Neurology and Neurosurgery, Faculty of Advanced Studies and professional retraining of specialists.

49, Butlerov St., Kazan, 420012

dhasanova@mail.ruhttps://orcid.org/0000-0003-3351-7770АгафоноваН. В.AgafonovaN. V.

Агафонова Наталья Васильевна - врач-невролог неврологического отделения.

420101, Казань, ул. Карбышева, д. 12а

Nataly V. Agafonova, Neurologist of the Neurological Department.

12a, Karbyshev St., Kazan, 420101

Agafonova_nataly@list.ruГоспиталь для ветеранов войн г. Набережные ЧелныРоссияHospital of War Veterans, Naberezhnye ChelnyRussian FederationКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian FederationМежрегиональный клинико-диагностический центрРоссияInterregional Clinical and Diagnostic CenterRussian Federation202107082021010101107Copyright © Крылова Л.В., Хасанова Д.Р., Агафонова Н.В., 20212021Крылова Л.В., Хасанова Д.Р., Агафонова Н.В.Krylova L.V., Khasanova D.R., Agafonova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6270

Спастичность является одним из наиболее частых двигательных нарушений, и ее развитие связано с такими поражениями центральной нервной системы (ЦНС), как инсульт, рассеянный склероз, церебральный паралич, черепно-мозговая и спинальная травмы, опухоли ЦНС, нейродегенеративные заболевания. Постинсультная спастичность развивается примерно у 40% пациентов, тяжелую и инвалидизирующую спастичность имеют около 15% пациентов. Согласно статистическим данным, после черепно-мозговых травм примерно у 75% пациентов развивается спастичность, при этом половине из них требуется лечение. Спастичность ухудшает ходьбу, затрудняет гигиену, одевание, затрудняет реабилитационные мероприятия, снижает качество жизни пациента и членов его семьи. В последние годы это двигательное нарушение активно изучается, появились новые сведения о патофизиологии спастического пареза и обнадеживающие данные по улучшению функции у пациентов, получающих в рамках мультидисциплинарной реабилитации инъекции ботулотоксина.

В статье представлены данные последних систематических обзоров по эффективности различных реабилитационных технологий для лечения спастичности, в т. ч. с применением ботулинического токсина типа А.

Применение ботулинического нейротоксина для лечения спастического пареза верхней и нижней конечностей является предпочтительным методом комплексной мультидисциплинарной реабилитации пациентов со спастичностью и имеет наивысший уровень доказательности.

В настоящее время не вызывает сомнений, что ботулотоксин должен применяться как можно раньше у пациентов с формирующимся патологическим двигательным паттерном, что может способствовать его изменению и сохранению длины мышцы. Но остается открытым вопрос, какая реабилитационная технология наиболее эффективна для усиления и пролонгации действия ботулинического нейротоксина. На сегодняшний день на него нет однозначного ответа.

Spasticity is one of the most frequent movement disorders and its development is associated with such CNS lesions as stroke, multiple sclerosis, cerebral palsy, craniocerebral and spinal injuries, CNS tumors, neurodegenerative diseases. Post-stroke spasticity develops in about 40% of patients, and about 15% of patients have severe and disabling spasticity. According to statistics, after TBI, about 75% of patients develop spasticity, and half of them require treatment.

Spasticity worsens walking, complicates hygiene, dressing, complicates rehabilitation measures, and reduces the quality of life of patients and his family members. In recent years, this movement disorder has been actively studied, new data have appeared on the pathophysiology of spastic paresis and encouraging data on improving function in patients receiving botulinum toxin injections as part of multidisciplinary rehabilitation.

The article presents data from the latest systematic reviews on the effectiveness of various rehabilitation technologies for the treatment of spasticity.

The use of botulinum neurotoxin for the treatment of spastic paresis of the upper and lower extremities is the preferred method of complex multidisciplinary rehabilitation of patients with spasticity and has the highest level of evidence.

Currently, there is no doubt that botulinum toxin should be used as early as possible in patients with an emerging pathological movement pattern, which can contribute to pattern change and muscle length maintenance. But the question remains: which rehabilitation technology is most effective for enhancing and prolonging the action of botulinum neurotoxin. To date, there is no clear answer to this question.

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The authors declare that there are no conflicts of interest present.