medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-33-49-57medalphabet-1850Research ArticleСтатьиОсобенности диагностики и лечения ранней спастичности в нижней конечности после очагового повреждения головного мозгаDiagnostics and treatment features of early spasticity in lower limb due to focal brain damageДягилеваВ. П.DyagilevaV. P.

врач-невролог неврологического отделения для больных с нарушением мозгового кровообращения

Москва

Moscow

ГрибоваН. П.GribovaN. P.

д. м. н. проф., зав. кафедрой неврологии, физиотерапии и рефлексотерапии

г. Смоленск

Smolensk

ФГАУ «Национальный медицинский исследовательский центр «Лечебно-реабилитационный центр» Минздрава РоссииРоссияNational Medical Research Centre ‘Treatment and Rehabilitation Centre’Russian FederationФДПО ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава РоссииРоссияSmolensk State Medical UniversityRussian Federation202014012021033Неврология и психиатрия (4)4957Copyright © Дягилева В.П., Грибова Н.П., 20212021Дягилева В.П., Грибова Н.П.Dyagileva V.P., Gribova N.P.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-alphabet.com/jour/article/view/1850

Реабилитация пациентов, перенесших острое нарушение мозгового кровообращения (ОНМК) или тяжелую черепно-мозговую травму (ЧМТ), является одним из приоритетных направлений современной медицины. Двигательные нарушения встречаются у 77–81 % пациентов после инсульта. Развитие спастичности в нижней конечности в раннем восстановительном периоде способствует ухудшению реабилитационного прогноза и потенциала, ограничивает объем пассивных и активных движений, создает трудности при уходе за пациентом, снижает повседневную активность, затрудняет ношение ортезов, снижает эффективность реабилитационных мероприятий. В статье рассмотрены аспекты патофизиологии спастичности при очаговом повреждении головного мозга, обсуждаются возможности ранней диагностики и лечения спастичности в нижней конечности. Демонстрируются результаты оценки спастичности в нижней конечности с использованием клинических шкал, а также результаты моносинаптического тестирования в динамике у пациентов в раннем восстановительном периоде после очагового повреждения головного мозга. Полученные данные позволяют сделать заключение, что сочетанное применение нескольких диагностических методик позволяет наиболее рано верифицировать у пациента спастичность в нижней конечности. Обсуждается применение ботулинотерапии как наиболее таргетного и эффективного метода лечения спастичности в нижней конечности после очагового повреждения головного мозга в составе комплексной терапии.

Rehabilitation of patients after acute cerebrovascular accident or severe traumatic brain injury is one of the priority areas of modern medicine. Motor disorders occur in 77–81 % of patients after stroke. The development of spasticity in the lower limb in the early recovery period contributes to the deterioration of the rehabilitation prognosis and potential, limits the volume of voluntary movements, creates difficulties in patient care, reduces daily activity, creates difficulties in wearing orthoses, and reduces the effectiveness of rehabilitation measures. The article discusses aspects of the pathophysiology of spasticity in focal brain damage, discusses the possibility of early diagnosis and treatment of spasticity in the lower limb. demonstrates results of evaluation of spasticity in the lower limb using clinical scales, as well as the results of monosynaptic testing in dynamics in patients in the early recovery period after focal brain damage. The obtained data allow us to conclude that the combined use of several diagnostic techniques allows the earliest verification of spasticity in the lower limb in a patient. Discussed, that botulotoxin therapy can be used as the most targeted and effective method of treating spasticity in the lower limb after focal brain damage as part of complex therapy.

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