#1
|
||||
|
||||
Ãèïåðêèíåç ïîñëå ÎÍÌÊ.
Çäðàâñòâóéòå, óâàæàåìûå êîëëåãè. Ïàöèåíò, 60 ëåò, 7 ëåò íàçàä èøåìè÷åñêèé èíñóëüò â áàññåéíå ÏðÑÌÀ, óìåðåííûé ëåâîñòîðîííèé ãåìèïàðåç, ãåíåðàëèçîâàííûé àòåðîñêëåðîç, àíåâðèçìà áðþøíîãî îòäåëà àîðòû. Ñêîðåå âñåãî 3 ãîäà íàçàä áûë ïîâòîðíûé èíñóëüò â òîì æå áàññåéíå.  ïîñëåäíèå ãîäû îòìå÷àþòñÿ ãèïåðêèíåòè÷åñêèå äâèæåíèÿ â ëåâîé íîãå äâóõ òèïîâ: 1) ìèîêëîíè÷åñêîå ïîä¸ðãèâàíèå (âíå çàâèñèìîñòè îò äâèæåíèÿ) 2) òîíè÷åñêîå ñêðó÷èâàíèå ñòîïû (÷àùå áåçáîëåçíåííîå, íî ìîæåò áûòü è ñ áîëüþ), êîòîðîå ÷àùå âñåãî ïðîâîöèðóåòñÿ äâèæåíèåì (õîäüáîé) è ïðîäîëæàåòñÿ íåñêîëüêî ìèíóò, åñëè ïðåêðàòèòü äâèæåíèå. Ñîáñòâåííî, èç-çà ïîñëåäíåãî õîäèòü íå ìîæåò. Ðàñöåíèâàþ âòîðîé ãèïåðêèíåç, êàê ñèìïòîìàòè÷åñêóþ ìûøå÷íóþ äèñòîíèþ. Áîòóëèíîòåðàïèÿ íå ïðåäñòàâëÿåòñÿ âîçìîæíîé èç-çà òåððèòîðèàëüíîãî è ôèíàíñîâîãî ôàêòîðà. Âîçìîæíî ëè íàçíà÷åíèå êëîíàçåïàìà íà äëèòåëüíûé ñðîê âìåñòî ïðåãàáàëèíà, èëè ëåâîäîïû? Ïðîøó ñîâåòà â ïîñòàíîâêå äèàãíîçà è ëå÷åíèÿ. Ñåé÷àñ ïðèíèìàåò ëèðèêó 75 ìã - 2 ðàçà â ñóòêè.
|
#2
|
||||
|
||||
ïèøóò ÷òî äèñòîíèè ïëîõî ïîääàþòñÿ ëå÷åíèþ ïåðîðàëüíûìè ïð-òàìè, èç êîèõ íàçíà÷àþòñÿ ñ ïåðåìåííûì óñïåõîì:
Dystonia following stroke usually has a poor response to medical therapy, typically being refractory to oral medications. Anticholinergic drugs,27 benzodiazepines,21 baclofen, and dopamine depleting/blocking agents21 have reported benefits for some patients. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
|
||||
|
||||
åùå çäåñü:
...the benzodiazepines clonazepam and diazepam were the most effective medications with 50% of trials resulting in at least some benefit. In the literature, anticholinergic drugs were most effective with 41% of trials resulting in benefit... The natural history and treatment of acquired hemidystonia: report of 33 cases and review of the literature. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
|
||||
|
||||
Äà, âîçìîæíî, êëîíàçåïàìà èìåííî ïðè ìèîêëîíèôîðìíûõ äèñòîíèÿõ. Ëåâîäîïà ïðè òàêîì ôîêàëüíîì ïðÿâëåíèè âðÿä-ëè ïîìîæåò, íî ïîïðîáîâàòü òîæå ìîæíî è íóæíî.
Óíèâåðñàëüíîãî ëå÷åíèÿ íåò ( åñëè íåò âîçìîæíîñòè äëÿ áëîêàäû áîòóëèíîòîêñèíîì), íàäî ïðîáîâàòü, ÷òî ïîìîæåò, ìîæåò è âîîáùå íè÷åãî íå ïãìî÷ü. Ýòî òî÷íî íå ïðîÿâëåíèå ñïàñòèêè? Ó ìíîãèõ ïàöèåíòîâ íà ìîåé ïðàêòèêå áûë òàêîå âîò àêòèâèðóåìîå äâèæåíèåì «ñêðó÷èâàíèå» è (ìèî)êëîíèôîðìíîå ïîäåðãèâàíèå â ïîðàæåííîé êîíå÷íîñòè, êîòîðîå â êîíå÷íîì èòîãå çíà÷èòåëüíî óìåíüøàëîñü èëè èñ÷åçàëî ïîñëå ââåäåíèÿ è ïîäíÿòèÿ äîçû áàêëîôåíà |
#5
|
||||
|
||||
Öèòàòà:
|
#6
|
||||
|
||||
Sirdalut, tolperison
Êàê âû äîçèðîâàëè áàêëîôåí, Íèêîëàé Èâàíîâè÷? Íåìåäèêàìåíòîçíàÿ òåðàïèÿ ïàöèåíòó ïðîâîäèòñÿ? |
#7
|
||||
|
||||
Áàêëîôåí íå ÿ íàçíà÷àë, äðóãîé âðà÷, íî ñî ñëîâ - î÷åíü ïëîõî ïåðåíîñèë. Ñèðäàëóä ÿ íàçíà÷àë, íî áûëà âûðàæåííàÿ îáùàÿ ñëàáîñòü, äàæå â ìàëûõ äîçàõ. Ìèäîêàëì íå ïîìîãàë. (ýòî äëÿ òîíóñà). Íåìåäèêàìåíòîçíàÿ òåðàïèÿ - ýòî ËÔÊ? Êàê - òî ó íàñ ïðîáëåìàòè÷íî ñ ýòèì, íî ìîæíî åùå ïîèñêàòü êîãî-íèáóäü èç èíñòðóêòîðîâ.
|
#8
|
||||
|
||||
Ïëîõî åòî êàê? Òåðÿë òîíóñ?
Ìîæíî, êîíå÷íî, òåòðàçåïàì ïîïðîáîâàòü åøå Êîíå÷íî, èäåàëüíûì âàðèàíòîì áûëî áû ëîêàëüíî áîòóëîòîêñèí.. |