痙縮に対する治療ストラテジー

Selection of Treatment Modalities in Patients with Spasticity

痙縮の治療には，これまで内服薬，ブロック療法，外科的手術療法などが行われ，患者の症状に応じて治療法が選択されてきた。近年，ボツリヌス療法，バクロフェン持続髄注療法も新たな治療方法として選択肢に加わり，痙縮治療の幅が広くなってきている。また，これらの治療法はリハビリテーションと併用することで，より効果的なものとなる。今回，各治療法の特徴について述べるとともに，その適応についても言及する。

Abstract

Spasticity is the most common abnormality of muscle tone. Typically, oral antispastic drugs, phenol blocks, motor-point blocks, selective dorsal rhizotomies, and selective peripheral neurotomies are used to reduce muscle tone and/or improve ranges of motion. Recently, botulinum toxin injections and intrathecal baclofen have been used as treatment modalities. The selection of the most appropriate treatment modality by doctors treating patients with spasticity is critical. Furthermore, rehabilitation techniques, such as physiotherapy, occupational therapy, therapeutic electrical nerve stimulation, and orthosis, are useful as combination therapy for the treatment of spasticity. The purpose of this study was to outline the various modalities that are currently used for the treatment of spasticity. Regardless of the modality selected, it is imperative that treatment goals are carefully identified. The reduction of spasticity is not an appropriate treatment goal. Appropriate goals include improving gait, activities of daily living, and the quality of life.