Estimulación espinal para la espasticidad: enfoques históricos, estado actual y tendencias futuras.
Artículo publicado en: Neuromodulation 2017;20:307-21 Traducción: Dr. Juan Carlos Andreani.
DOI:
https://doi.org/10.47924/neurotarget201887Palabras clave:
daño medular traumático, espasticidad, estimulación epidural, estimulación medular espinal, motoneuronas, pruebas clínicas, reflejo HResumen
Introducción: La espasticidad es una condición relacionada a daño cerebral o de la médula espinal que afecta a millones de personas en el mundo, causada a menudo por eventos como accidente cerebro – vascular, daño traumático cerebral o medular, aunque es también común un comienzo insidioso del padecimiento. Sin desmedro de la causa, la espasticidad resultante llevará a años de discapacidad y calidad de vida reducida. Se dispone de varios tratamientos para esta condición mórbida, aunque cada uno de ellos está gravado con inconvenientes, incluyendo respuesta clínica incompleta, alto costo, duración limitada de respuesta, efectos colaterales limitantes relacionados a la dosis, y necesidad de mantenimiento periódico. La estimulación medular (EM), alguna vez promisorio tratamiento para la espasticidad, ha sido relegada a un estado experimental permanente.
Métodos.En esta revisión, nuestro objetivo es documentar y criticar la historia y evaluar el desarrollo de SCS como tratamiento de la espasticidad de las extremidades inferiores. Al incorporar los descubrimientos recientes con los conocimientos adquiridos por los primeros pioneros en este campo, tenemos la intención de sentar las bases necesarias para proponer hipótesis comprobables para estudios futuros.
Resultados. La EM ha sido probada en más de 25 condiciones diferentes desde que se reportó un efecto potencialmente beneficioso en 1973. Sin embargo, la falta de una comprensión completa de la fisiopatología de la espasticidad, la metodología de estudio arcaica y las limitaciones tecnológicas iniciales del hardware implantable limitan la validez de muchos estudios. SCS ofrece una medida de control de la espasticidad que no se puede reproducir con otras intervenciones.
Conclusiones. Con una mejor miniaturización de la fuente de energía, algoritmos de control personalizados, un diseño de implantes más desarrollado y una mayor comprensión de la fisiopatología de la espasticidad estamos preparados para reintroducir y volver a probar la EM en esta población.
Métricas
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Derechos de autor 2018 Sean J. Nagel, Saul Wilson, Michael D. Johnson, Andre Machado, Leonardo , Matthieu K. Chardon, Chandan G. Reddy, George T. Gillies, Matthew A. Howard III
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
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