Beyin felçli çocuklarda spastisitenin tedavisi

Spastisitenin tedavisi rehabilitasyon ekibi için zorlu bir iştir. Başlangıç tedavisi, ağırlaştırıcı dış nedenlerin ortadan kaldırılması, fizik tedavi, atel ve alçılama üzerine yoğunlaşmıştır. Medikal tedavide ise ağırlık spastisiteye karşı ilaç tedavisindedir; ancak, son zamanlarda fenol blokları ve botulinum toksini gibi fokal tedavi yöntemlerinden de yararlanılmaktadır. İlaçlara dirençli tonusun tedavisinde intratekal baklofen kullanımı giderek yaygınlaşmaktadır. Spastik çocukların seçilmiş bir kısmında dorsal rizotomi uygulaması da savunulan yöntemlerden biridir. Spastisitenin tedavisinde standartlaşmış bir yaklaşım bulunmamaktadır. Bu yazıda spastisitede çocuğa özel ve kanıta dayalı tedavinin önemi vurgulanmıştır.

Anahtar Kelimeler:

Botulinum toksin, tip A, Beyin felci, Çocuk, Enjeksiyon, spinal, Hareket bozuklukları, Baklofen, Kas spastisitesi, Dantrolen

Management of spasticity in children with cerebral palsy

Management of spasticity is a major challenge to the reha- bilitation team. The initial management has centered on the elimination of externally exacerbating causes, physical ther- apy, splinting and casting. Medical management has centered on anti-spasticity medication use, but more recently focal treatment methods including phenol blocks and botulinum toxin have been utilized. There has been an increased use of intrathecal baclofen in the management of refractory tone. Dorsal rhizotomy has been advocated for a selective population of children with spasticity. There is no standardized approach to spasticity management and this paper will discuss the importance of evidence-based treatment of spasticity that is adapted for the individual child.

Keywords:

Botulinum Toxins, Type A, Cerebral Palsy, Child, Injections, Spinal, Movement Disorders, Baclofen, Muscle Spasticity, Dantrolene,

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