Terapêuticas Não-Farmacológicas Adjuvantes Após Injeção de Toxina Botulínica para o Controlo de Espasticidade: Revisão Narrativa

Eduardo Estribio Gonçalves, Alexandre Camões-Barbosa, Denise Marruaz, Duarte Calado, Sergio Pinho

Resumo


Introdução: O objetivo foi expor a evidência científica das opções terapêuticas adjuvantes da toxina botulínica no controlo da espasticidade.

Métodos: Revisão narrativa da literatura publicada nas bases de dados Medscape, Cochrane Library e PubMed até Dezembro de 2020. Os termos utilizados na pesquisa foram: “botulinum toxin”, “spasticity”, “adjunct therapy”. Da pesquisa surgiram um total de 137 artigos. Foram excluídos relatos de caso, artigos de rigor metodológico duvidoso e artigos não referentes especificamente ao objetivo do trabalho. Foram incluídos estudos de metanálise, revisões sistemáticas e narrativas e ensaios clínicos controlados e randomizados. Após aplicação dos critérios referidos foram selecionados 23 artigos.

Resultados: A evidência científica das diferentes opções terapêuticas identificadas foi dividida nas seguintes modalidades: fisioterapia/cinesiterapia (alongamentos, treino funcional e outras intervenções), ortóteses, imobilizações gessadas, bandas funcionais, modified constraint-induced movement therapy e agentes físicos (eletroestimulação, ultrassons, ondas de choque extracorpóreas e vibração). Foram também identificados estudos comparativos entre modalidades terapêuticas após a aplicação de BoNT-A.

Duma forma geral verificou-se escassez de evidência da eficácia das várias modalidades referidas e nalguns casos, evidência da ausência de benefício de certas associações.

Ainda assim, foram identificados ensaios clínicos com intervenções promissoras nomeadamente recorrendo a fisioterapia com associação de técnicas, electroestimulação e ondas de choque. Foram também identificados estudos comparativos que parecem indicar superioridade da electroestimulação e bandas funcionais em relação aos alongamentos, superioridade da terapia por ondas de choque em relação à electroestimulação e superioridade das imobilizações gessadas comparativamente aos alongamentos.

Conclusão: A escolha da terapêutica adjuvante específica está limitada pela evidência científica disponível, devendo a seleção ir ao encontro das particularidades do doente e recursos de reabilitação. Ainda assim, a prescrição de fisioterapia com recurso a várias técnicas incluindo treino funcional parece ser a terapêutica adjuvante com maior benefício. Com menor evidência de benefício, mas ainda assim de razoável adoção, são de referir a electroestimulação motora, terapia por ondas de choque extracorpóreas e, pontualmente, o uso de ortóteses imobilizadores de uso intermitente. As intervenções que parecem ter menor utilidade são os ultrassons, o taping, a vibração corporal e os alongamentos quando aplicados de forma isolada.


Palavras-chave


Espasticidade Muscular/tratamento; Estimulação Elétrica Nervosa Transcutânea; Toxinas Botulínicas; Tratamento por Ondas de Choque Extracorpóreas

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DOI: http://dx.doi.org/10.25759/spmfr.430

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