Distonia: uma revisão de escopo sobre alternativas terapêuticas à toxina botulínica
Data
2022-02-09
Autores
Oliveira, Matheus Guilherme de Souza [UNIFESP]
Orientadores
Melo, Daniela Oliveira de [UNIFESP]
Tipo
Trabalho de conclusão de curso de graduação
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O termo “distonia” descreve um distúrbio do movimento caracterizado por contrações musculares sustentadas ou intermitentes, de modo a produzir movimentos e/ou posturas anormais. Causa movimentos estereotipados, com frequência iniciada ou exacerbada por movimento ou postura, associada a ativação celular excessiva, sendo uma condição altamente estigmatizante e incapacitante. O tratamento é geralmente sintomático, baseado no alívio das contrações musculares. Objetivo Mapear revisões sistemáticas que tenham avaliado intervenções farmacológicas alternativas ou adjuvantes à toxina botulínica disponíveis para o tratamento de distonia. Materiais e Métodos: Foi realizada busca nas bases Medline (via Pubmed), Embase, Epistemonikos e Cochrane Library. Posteriormente seguiu-se com a elegibilidade por leitura de resumo e título e ainda de texto completo. Então, um revisor realizou a extração dos dados e o agrupamento das revisões referente à cada tecnologia avaliada. Resultados: Obteve-se o número de 828 artigos, parmanecedo apenas 15 após a seleção das revisões sistemáticas que tratavam de terapias alternativas à toxina botulínica para distonia. Destas, 3 trabalhos (20%) tratavam sobre distonia cervical, 8 (53%) avaliaram distonia generalizada e 4 (27%) tratavam de mais de um tipo de distonia. Quanto aos fármacos avaliados 8 trabalhos avaliaram triexifenidil, 5 avaliaram baclofeno, 4 levodopa, e zolpidem, tetrabenazina, dronabinol e risperidona foram avaliaram por 2 revisões cada. Apenas uma revisão apresentou resultados a partir de metanálise. 6 revisões não especificaram critérios de inclusão para os estudos primários utilizados e apenas duas aplicaram restrições de idade da população estudada. Discussão e Conclusão: Poucos estudos tratam de intervenções farmacológicas alternativas à toxina botulínica, sendo que grande parte delas avalia intervenções a nível sistêmico. Muitos estudos apresentam baixa qualidade de evidência e elevado risco de viés. Portanto, a toxina botulínica ainda é o tratamento de primeira escolha, apesar de ser mais indicada para distonias focais e/ou segmentares. Não há ainda uma alternativa terapêutica tão eficaz quanto a esta para o tratamento de distonias generalizadas.
The “dystonia” term describes a movement disorder characteryzed by sustained or intermittent muscle contractions, so that produce abnormal movements and/or postures. It causes stereotyped movements, with frequency iniciated or exacerbated by movement or posture, associated to excessive cell ativation, making it a highly stigmatizing and crippling. The tratment is usually symptomatic, based on the muscle contractions relief. Objective: To map systematic reviews that have evaluated alternative or adjuvant available pharmacological interventions to botulinum toxin in the treatment of dystonia. Materials and Methods: A Search was performed on Medline (via Pubmed), Embase, Epistemonikos and Cochrane Library Results: 828 articles were obtained, only remaining 15 after the selection of those who evaluated alternative therapies to botulinum toxin for dystonia. Of these, 3 reviews (20%) studied cervical dystonia, 8 (53%) analyzed generalized dystonia and 4 (27%) surveyd more than one type of dystonia. As for the evaluated drugs 8 reviews analyzed trihexyphenidyl, 5 baclofen, 4 levodopa and zolpidem, tetrabenazine, dronabinol and risperidone were evaluated by 2 reviews each. Only one review broaded results from meta-analysis. 6 reviews have not specified inclusion criteria for the primary studies used and only two applied population age studied restrictions. Discussion and Conclusion: Few studies broad alternative pharmacological interventions to botulinum toxin, once most of them evaluate interventions at systemic level. Many studies broad low quality of evidence and high bias risk. Therefore, the botulinum toxin still remains the treatment of first choice, despite being more indicated for focal and/or segmental dystonias. There is still no therapeutic alternative as effective as it toxin for generalized dystonias treatment.
The “dystonia” term describes a movement disorder characteryzed by sustained or intermittent muscle contractions, so that produce abnormal movements and/or postures. It causes stereotyped movements, with frequency iniciated or exacerbated by movement or posture, associated to excessive cell ativation, making it a highly stigmatizing and crippling. The tratment is usually symptomatic, based on the muscle contractions relief. Objective: To map systematic reviews that have evaluated alternative or adjuvant available pharmacological interventions to botulinum toxin in the treatment of dystonia. Materials and Methods: A Search was performed on Medline (via Pubmed), Embase, Epistemonikos and Cochrane Library Results: 828 articles were obtained, only remaining 15 after the selection of those who evaluated alternative therapies to botulinum toxin for dystonia. Of these, 3 reviews (20%) studied cervical dystonia, 8 (53%) analyzed generalized dystonia and 4 (27%) surveyd more than one type of dystonia. As for the evaluated drugs 8 reviews analyzed trihexyphenidyl, 5 baclofen, 4 levodopa and zolpidem, tetrabenazine, dronabinol and risperidone were evaluated by 2 reviews each. Only one review broaded results from meta-analysis. 6 reviews have not specified inclusion criteria for the primary studies used and only two applied population age studied restrictions. Discussion and Conclusion: Few studies broad alternative pharmacological interventions to botulinum toxin, once most of them evaluate interventions at systemic level. Many studies broad low quality of evidence and high bias risk. Therefore, the botulinum toxin still remains the treatment of first choice, despite being more indicated for focal and/or segmental dystonias. There is still no therapeutic alternative as effective as it toxin for generalized dystonias treatment.