10 research outputs found

    The Effectiveness of Combining Botulinum Toxin Type A and Therapeutic Exercise in Treating Spasticity in a Patient with Complicated Stiff-Person Syndrome: A Case Report

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    Stiff-person syndrome is rare and disabling autoimmune condition that most frequently affects women, with no real predisposition by race. Diagnosis is often arduous, which is why patients concomitantly suffer from anxiety and depression. To date, drug therapy is based on the use of benzodiazepines, barbiturates, and baclofen. Refractory cases are treated with intravenous immunoglobulin, plasmapheresis, B lymphocyte depletion with rituximab, and even the implantation of intrathecal baclofen devices. Botulinum toxin injection is frequently used, even if it still has an unclear role in the literature. Our case report aims to demonstrate the efficacy of a combined treatment of botulinum toxin and therapeutic exercise in a 65-year-old patient with biceps brachii muscle hypertonia and diffuse spasms of the axial musculature, using rating scales such as the Numeric Rating Scale (NRS) and Modified Ashworth Scale (MAS), joint range of motion (ROM) measurement, and muscle dynamic stiffness mensuration, which is performed by using the MyotonPro®. All the assessments were conducted at the first evaluation (T0), soon after the combined treatment with botulin toxin and therapeutic exercise (T1), three months (T2), six months (T3), and eight months after the botulinum toxin injection (T4). The patient demonstrated benefits for more than 6 months with no side effects. The combined therapy of botulinum toxin and therapeutic exercise had an excellent result in our patient

    Effects of Intradermal Therapy (Mesotherapy) on Bilateral Cervicobrachial Pain

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    Background: Mesotherapy is a procedure or a process of injecting drugs into the skin. This technique can help decrease the total drug dose due to its drug-sparing effect on the systemic route and can be utilized to treat nonspecific neck pain that occurs in the lateral and posterior neck. Methods: Ten patients with bilateral cervicobrachial pain were recruited and evaluated at T0 before treatments, T1 at the end of the treatment (42 days after T0), and T2 (72 days after T0). Assessments consisted of performing the Visual Analogue Scale (VAS) to evaluate pain evolution; a range of movement (ROM) and Bilateral trapezius’ tone, elasticity, and dynamic stiffness mensuration were performed using MyotonPro®. All patients underwent mesotherapy treatment in the trapezius muscles with 1 cc of Diclofenac Sodium and 1 cc of lidocaine diluted in 3 cc of saline for a total of 6 weeks. Results: VAS value statistically decreased at T1 and T2; ROM of neck flexion statistically increased at T1 and T2, and miometric tone and stiffness value statistically improved at T1 and T2. Conclusion: mesotherapy with Diclofenac Sodium reduced pain intensity and improved functional outcomes, with no significant adverse effects in patients with myofascial pain syndrome of cervicobrachial localization

    Intrathecal Baclofen Infusion-Botulinum Toxin Combined Treatment Efficacy in the Management of Spasticity due to Cerebral Palsy

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    Background: Cerebral Palsy (CP) is a group of permanent, but not unchanging, disorders of movement and/or posture and motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain. One clinical presentation is muscle spasticity, which leads to a significant impact on the individual's functionality and quality of life. Spasticity treatment is multidisciplinary and includes pharmacological and physical intervention; intrathecal baclofen shows a positive effect in severe spasticity and suboptimal response to oral drugs, while local injection of Botulinum toxin type A (BTXA) improves muscle tone, motion and pain. Objective: The aim of this study was to evaluate the efficacy of the combined intrathecal baclofen infusion (ITB) - botulinum toxin treatment in the management of spasticity in CP. Methods: 8 patients with spastic tetraparesis were enrolled. All patients were treated with intrathecal Baclofen; in lower limbs, no spastic symptoms appeared, while marked spasticity was noted in upper limbs. We injected the right and left Biceps Brachial (BB) and Flexor Digitorum Superficialis (FDS) muscles with botulinum toxin type A. All patients underwent Myometric measurement, Ashworth Scale, Numerical Rating Scale, and Visual Analogic Scale evaluation before infiltration (T0), 30 days after injection (T1), 60 days after injection (T2), and 90 days after treatment (T3). Results: All data demonstrated an improvement in spasticity, pain, quality of life, and self-care during the study, with p < 0.05. No side effects appeared. Conclusion: This study demonstrated the efficacy and safety of intrathecal baclofen infusion and botulinum toxin combined treatment in the management of spasticity, pain, quality of life, and selfcare in CP patients

    [Development of a conceptual model for interpretation of monitoring indicators of childhood obesity prevention from the Italian National Prevention Plan] Sviluppo di un modello concettuale di riferimento per l\u2019interpretazione degli indicatori di prevenzione dell\u2019obesit\ue0 infantile e nell'adolescenza nel Piano nazionale della prevenzione

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    INTRODUZIONE: il Piano nazionale della prevenzione (PNP) 2014-2018 ha indicato alle Regioni obiettivi e strategie per la prevenzione dell\u2019obesit\ue0 e si \ue8 dotato di un sistema di valutazione d\u2019impatto. OBIETTIVI: sviluppare un modello per l\u2019interpretazione delle variazioni negli indicatori relativi all\u2019obesit\ue0 infantile e nell\u2019adolescenza. METODI: da una revisione sistematica, DPSEEA (\uabforze trainanti\ubb, \uabpressioni\ubb, \uabstato\ubb, \uabesposizione\ubb, \uabeffetto\ubb, \uabazioni\ubb) \ue8 risultata la cornice concettuale pi\uf9 completa e applicabile. Un gruppo di esperti ha identificato determinanti e nessi causali e possano agire gli interventi proposti dal PNP come su questi. Il modello finale \ue8 stato ottenuto attraverso un processo iterativo che ha coinvolto un comitato consultivo di decisori e rappresentanti di societ\ue0 scientifiche. RISULTATI: \uabforze trainanti\ubb identificate sono legate a profitto dell\u2019industria alimentare, all\u2019alimentazione scolastica, al contesto domestico. Tra le \uabPressioni\ubb rientrano abitudini familiari, offerta delle mense scolastiche e fattori socioculturali, contesto di vita, organizzazione dell\u2019attivit\ue0 fisica (AF) scolastica ed extra-scolastica. Nello \uabstato\ubb sono inclusi: frequente consumo di cibo confezionato, alta quantit\ue0 di cibo ipercalorico disponibile, mancanza del pasto in famiglia, consumo di bevande gasate e zuccherate, interruzione precoce dell\u2019allattamento al seno, scarsa fruibilit\ue0 di spazi esterni, frequente uso del trasporto privato e scarsa offerta di AF nelle scuole. \uabEsposizione\ubb sono le opportunit\ue0 di AF e apporto calorico, che agiscono su \uabeffetto\ubb (prevalenza di obesit\ue0). CONCLUSIONI: il modello interpretativo colloca le \uabazioni\ubb e i meccanismi che dovrebbero modificare AF e apporto calorico, in una sequenza causale, rendendo esplicito il costrutto degli indicatori di monitoraggio e d\u2019impatto.BACKGROUND: the Italian National Prevention Plan (PNP) posed the standard to be achieved by Regions for the prevention of obesity in childhood and adolescence. The PNP also set up a monitoring system to assess the impact of implemented policies. OBJECTIVES: to develop a conceptual model to facilitate interpretation of variation in outcome indicators. METHODS: after a systematic review, the DPSEEA (\uabDriving forces\ubb, \uabPressures\ubb, \uabState\ubb, \uabExposure\ubb, \uabEffect\ubb, \uabActions!) was identified as the more appropriate framework to assess the results of preventive policies. Factors for each component of the framework were identified and indicators that allow measuring the changing of each of these factors were defined. RESULTS: the included \uabdriving forces\ubb were related to the profit-led food industry, to the nutrition environment at school, and to household-level factors. Among the \uabpressures\ubb, parenting behaviours, food provided by school canteens, sociocultural factors, social context, physical activity (PA), opportunities at school or after-school were included. In the State, the high consumption of processed food, the large quantities of high-calorie food easy available, the consumption of carbonated and sugar-sweetened beverages, the reduced social function of mealtimes in families, the early cessation of breastfeeding, the reduction of outdoors activity, active transportation, and PA at school for children were identified. The \uabexposure\ubb factors were the reduced opportunities of doing PA and the over-consumption of calories that influence the \uabeffect\ubb, described as the prevalence of children and adolescents affected by obesity. CONCLUSIONS: through the DPSEEA, a conceptual model was set up; it allows to place in the causal chain the \uabactions\ubb and the mechanisms through which these actions should impact on the \uabexposure\ubb (PA and over-consumption of calories), making the rationale of process and impact indicators explicit
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