Diferenciación clínica de la espasticidad y la distonía espástica tras ictus crónico con electromiografía de superficie: una serie de casos
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Resumen
Introducción: La espasticidad afecta a un gran número de pacientes con ictus, limitando su movilidad y autonomía. La electromiografía de superficie (sEMG) es la opción más adecuada para cuantificar la espasticidad y diferenciarla de otros fenómenos. A pesar de la evidencia del efecto de la punción seca sobre la espasticidad, no se ha cuantificado mediante sEMG ni se han explorado otros patrones de hiperactividad muscular.
Presentación del caso: Se presentan 4 casos de pacientes con ictus crónico y espasticidad, que recibieron terapia intensiva durante 4 semanas, combinada con una sesión semanal de punción seca ecoguiada en el músculo gastrocnemio medial. Se evaluó la actividad muscular mediante sEMG en reposo y durante el estiramiento, la escala Ashworth modificada (MAS) y pruebas de marcha al comienzo del estudio (T0), tras la primera sesión de punción seca (T1) y al final del tratamiento (T2). Se identificaron distintos fenotipos según la actividad electromiográfica: alta actividad durante el estiramiento, alta variabilidad, alta actividad tanto en reposo como en estiramiento y combinación de las anteriores.
Resultados: La actividad electromiográfica durante el estiramiento se redujo en los casos con alta respuesta y variabilidad al estiramiento sin distonía espástica, mientras que la actividad en reposo se redujo en los casos que sí presentaban distonía espástica. La escala MAS mejoró en todos los pacientes y las pruebas de marcha superaron los umbrales clínicamente significativos. No se registraron efectos adversos.
Conclusiones: Se propone un marco teórico-práctico para la valoración del tono mediante sEMG, describiendo distintos fenotipos clínicos en pacientes con ictus crónico y respaldando la combinación de punción seca y terapia intensiva para mejorar tanto la espasticidad como la marcha.
Palabras clave
- Punción seca
- Electromiografía de superficie
- Espasticidad
- Distonía espástica
- Ictus
- Terapia intensiva
- Neurorrehabilitación
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