#46
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#47
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#48
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#49
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#50
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Цитата:
Разгибать руку и даже распремлять ладонь она научилась (правда все это связано с большими физическими напряжениями для нее). Я стараюсь помочь ей научиться быстро расслаблять руку |
#51
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Врачам не следует забывать, что для снижения повышенного мышечного тонуса при спастических параличах применяются миорелаксанты, например баклофен, тизанидин, что значительно облегчает реабилитацию.
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#52
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#53
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#54
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1: Zh Nevrol Psikhiatr Im S S Korsakova. 2006;106(1):34-42. Links [A randomized, double blind, placebo-controlled study of the efficacy and safety of tolperisone in spasticity following cerebral stroke] [Article in Russian] Stamenova P, Koytchev R, Kuhn K, Hanasen C, Horvath F, Ramm S, Pongratz D. To study the efficacy and safety of tolperisone--a centrally acting muscle relaxant with membrane stabilizing activity--in the treatment of stroke-related spasticity. This was a randomized, double-blind, placebo-controlled, multicenter study with parallel groups. Treatment lasted 12 weeks and was started with a titration period of variable length (dose range 300-900 mg tolperisone daily). The degree of spasticity determined on the Ashworth Scale in the most severely affected joint area was denned as primary target parameter. Hundred and twenty patients (43 females, 77 males) in a mean age of 63,3 +/- 10,6 years were recruited and received treatment. In the majority of patients both limbs of each side were affected by the spasticity which on average had been present for 3,3 +/- 4,4 years. A 62% of the patients were treated with a daily dose >600 mg tolperisone. Tolperisone reduced the mean Ashworth Score by a mean of 1,03 +/- 0,71 compared with a mean reduction of 0,47 +/- 0,54 in the placebo group (p<0,0001). A 78,3% of the patients on tolperisone versus 45% of the placebo patients experienced a reduction by at least 1 point on the Ashworth Scale (p<0,0001). Functional and overall assessments of efficacy confirmed superior efficacy of tolperisone. Adverse events occurred less often on active treatment (n=19) than on placebo (n=26) and were mostly of mild-to-moderate intensity. No withdrawals caused by adverse events were reported in the tolperisone group. The findings of the present study demonstrate the efficacy and excellent tolerance of tolperisone in the treatment of spastic hypertonia following cerebral stroke. Study data further suggest that an individual dose titration which may exceed the recommended maximum dose of 450 mg daily results in optimized therapeutic benefit. |
#55
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А вообще работы по антиспастическому эффекту проводились на небольших группах пациентов, эффект был показан, но имеются замечания к методологии исследования.
Neurology. 2005 Jun 14;64(11):1989-90; author reply 1989-90. Oral antispastic drugs in nonprogressive neurologic diseases: a systematic review. Montane E, Vallano A, Laporte JR. Unitat d'Assaigs Clinics i Farmacoepidemiologia, Servei de Farmacologia Clinica, Pg Vall d'Hebron, no 119-129, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain. OBJECTIVE: To assess the efficacy of oral drugs in the treatment of spasticity in patients with nonprogressive neurologic disease (NPND). METHODS: Systematic review of double-blind randomized controlled trials of antispastic oral drugs in the treatment of spasticity in NPND. DATA SOURCES: Electronic MEDLINE, PubMed, Cochrane Library, and hand searches. RESULTS: Twelve studies (469 patients) were included (6 on stroke, 3 on spinal cord diseases, and 3 on cerebral palsy). Tizanidine was assessed in four trials (276 patients, 142 exposed), dantrolene in four (103, 93), baclofen in three (70, 55), diazepam in two (127, 76), and gabapentin in one (28, all exposed). Most trials were of small size, of short duration, and their methodologic quality was inadequate. Ten trials were controlled with placebo and only two were direct comparisons between drugs. Efficacy outcome variables were heterogeneous. Only four reports described the magnitude of the antispastic effect. The incidence of adverse drug effects (drowsiness, sedation, and muscle weakness) was high. CONCLUSION: Evidence on the efficacy of oral antispastic drugs in NPND is weak and does not include evaluation of patients' quality of life. If any, efficacy is marginal. Adverse drug reactions were common. Better methodologic instruments are needed for the evaluation of antispastic treatment. |
#56
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Не забывать на мидокалм описаны аллергические реакции вплоть до анафилактического шока.
: Swiss Med Wkly. 2003 Jun 28;133(25-26):369-71. Links Anaphylactic reactions to tolperisone (Mydocalm). Ribi C, Vermeulen C, Hauser C. Division of Immunology and Allergy, University Hospital Generva, Switzerland. Four patients with anaphylaxis attributed to the intake of the centrally acting muscle relaxant tolperisone hydrochloride (Mydocalm) were observed at the Emergency Department of the Geneva University Hospital between November 2001 and March 2003. All patients were middle-aged women who took tolperisone for chronic muscular pain. All reactions occurred within an hour after oral intake of this drug frequently prescribed in Switzerland. The severity of anaphylaxis ranged from urticarial reactions to shock with arterial hypotension. Prick-to-prick skin testing performed in one patient with a tablet of tolperisone diluted in water was negative. Its globally restricted commercialisation may explain the lack of reports on such adverse effects in the MedLine database. Anaphylactic reactions to this drug, however, are mentioned in other sources such as the Swiss Drug Compendium and the WHO drug reaction database. Together, these findings suggest that anaphylaxis to tolperisone is not uncommon and should be known to physicians in countries where this drug is available. |
#57
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Только что наткнулся и подумал, что может быть и там можно пообщаться |
#58
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Вы же уже общаетесь в этой теме. Содержательные посты никогда не удаляются. А там собственно те же вопросы врачам, а не общение пациентов.
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#59
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Инсульт в 39 лет.
Прочитала очень внимательно все что было выше.
Восхищена упорством и мужеством! У моей сестры 3 мая 2007 произошел инсульт. Она живет в Минске и находится сейчас в Аксаковщине в Востановительном Центре. Парализовало левую часть, рука и нога. Рабочее давление было 190 вот и закончила инсультом+ нервная руководящая должность была.Никогда не принимала постоянных препаратов от давления.Только скорая сбивала скачки. Ходит потихоньку с поддержкой, рука восстанавливается быстрее чем нога.Рука уже не крючиться. Востанавливатеся речь очень быстро, у нее было онемение верхней челюсти и за неделю (звоню каждых 5 дней.т.к не с ней) слышны значительные изменения. ЕЕ очень волнует лицо.Как я поняла выкатились глаза.Один больше. а другой меньше. Что можно делать? Информацию я уже собираю, но. т.к. приходится просить маму. то все очень долго. Понимаю, что нужна докторам профессиональная информация, но может быть что-то на данном этапе посоветуете? Спасибо, Наташа |
#60
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Логичнее будет, если сестра или сама обратится за помощью или спросит совета у своего врача.
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