Tabla I. Estrategias para reducir el riesgo de producción de anticuerpos antitoxina botulínica. |
|
Temporales |
Esperar lo máximo posible entre las infiltraciones, al menos 10 semanas, aunque es preferible esperar 12 semanas |
Evitar infiltraciones de refuerzo |
|
Si se precisa toxina botulínica de tipo A en distintas regiones o para diferentes indicaciones (cefalea, distonía, sialorrea, etc.), tratar de sincronizar los ciclos de tratamiento |
|
Dosis |
Utilizar la menor dosis posible eligiendo el músculo correcto y utilizando una buena técnica de infiltración. Utilizar pruebas complementarias que permitan seleccionar mejor los músculos, como la electromiografía o la ecografía |
Exposición antigénica |
Evitar exposición a diferentes serotipos de toxina botulínica si no es necesario, tanto de forma secuencial como simultánea |
Reducir la carga proteica |
Tabla II. Formas clínicas de distonía cervical: frecuencia y músculos implicados (adaptado de [67]). |
|||
Desviación |
Origen |
Frecuencia |
Músculos implicados |
Cabeza (caput) |
Músculos distónicos insertados en el cráneo o la articulación atlantooccipital |
19,01% |
Esternocleidomastoideo, splenius capitis, splenius cervicis, parte descendente del trapecio, levator scapulae, longissimus capitis, obliquus capitis inferior, semiespinalis capitis, longus capitis, rectus capitis anterior/lateralis |
Cuello (collis) |
Músculos distónicos insertados en C2-C7 |
20,24% |
Levator scapulae, scalenus anterior, scalenus medius, semiespinalis cervicis, longissimus cervicis, longus colli |
Ambos |
60,73% |
Myths and evidence on the use of botulinum toxin: neuropharmacology and dystonia Introduction. Botulinum toxin type A (BTA) is a bacterial endotoxin, whose therapeutic use has had a dramatic impact on different neurological disorders, such as dystonia and spasticity. Aim. To analyze and summarize different questions about the use of BTA in our clinical practice. Development. A group of experts in neurology developed a list of topics related with the use of BTA. Two groups were considered: neuropharmacology and dystonia. A literature search at PubMed, mainly for English language articles published up to June 2016 was performed. The manuscript was structured as a questionnaire that includes those questions that, according to the panel opinion, could generate more controversy or doubt. The initial draft was reviewed by the expert panel members to allow modifications, and after subsequent revisions for achieving the highest degree of consensus, the final text was then validated. Different questions about diverse aspects of neuropharmacology, such as mechanism of action, bioequivalence of the different preparations, immunogenicity, etc. were included. Regarding dystonia, the document included questions about methods of evaluation, cervical dystonia, blepharospasm, etc. Conclusion. This review does not pretend to be a guide, but rather a tool for continuous training of residents and specialists in neurology, about different specific areas of the management of BTA. Key words. Bioequivalence. Botulinum toxin type A. Cervical dystonia. Focal dystonia. Focal hand dystonia. Neuropharmacological practice. |