In September of this year, the Santos Dumont Institute (ISD) launched a new multidisciplinary service, a pioneer in Rio Grande do Norte, for the treatment of patients with spasticity, a condition that causes an involuntary increase in muscle tone and impairs arm and leg movement. A team of physiotherapists, an orthopedist, a neurosurgeon and a biochemist listed and discussed the indication of botulinum toxin to meet the therapeutic objectives presented by the families of patients with the condition treated at the Anita Garibaldi Center for Health Education and Research (Anita). At the end of last week, the ISD welcomed physiatrists Suely Mitiko, from Goiás, and Liliana Jorge, from São Paulo, to monitor and discuss the application of the substance, guided by ultrasound, with the Institute's multidisciplinary team with the aim of improving treatment results.

Spasticity is a common disorder in congenital or central nervous system injuries, which can lead to functional incapacity, deformities and pain. Botulinum toxin acts to reduce spasticity and inhibits, for a period of time, the mechanism that increases reflex contraction. In September, three patients received the injection: two children and one adult. Last week, the substance was applied to three other users, between 4 and 12 years of age. In addition to the injection in the lower limbs, one of the children, who has myelomeningocele, also received botulinum toxin in the mandibular region to relax the facial muscles and promote better jaw articulation and the ability to chew and brush his teeth. 

“This moment was extremely important for strengthening and improving our Special Multidisciplinary Service for the Treatment of Spasticity (SEMENTE) at Anita. Dr. Suely Mitiko is a national reference in the application of botulinum toxin guided by ultrasound. This exchange of knowledge between services and professionals strengthens our actions in teaching and assisting our users,” comments the multidisciplinary physiotherapist preceptor at ISD, Camila Simão. 

The professionals used an ultrasound device to identify the muscle points with the greatest capacity to absorb botulinum toxin and enhance the effect of its application. In addition to being used for various diagnostics, ultrasound can be used in guided musculoskeletal procedures for motor or neurological rehabilitation. At ISD, there are two devices that, in addition to being used in this new type of service, are used on prenatal and urology patients, for example. 

“It is important to share new technical knowledge with the team. Dr. Suely explained and performed practical procedures for applying botulinum toxin guided by ultrasound and functional gait assessment, improving the care required in the rehabilitation program for neurological diseases of patients treated at Anita. This knowledge will remain and will be shared with other patients thanks to the training of doctors, physiotherapists, etc.”, commented Dr. Liliana Lourenço Jorge, physiatrist and assistant at Hospital das Clínicas (Lucy Montoro Rehabilitation Institute) and Hospital Israelita Albert Einstein, in São Paulo.

In addition to the application of botulinum toxin itself, the multidisciplinary team at ISD discussed, together with the invited physicians, how to enhance patient care. In parallel with the guided procedures, guidance was provided by the multidisciplinary physiotherapist Camila Simão to adapt the wheelchair of one of the patients who received the toxin.  

In addition to Suely Mitiko, Camila Simão and Liliana Lourenço Jorge, the administrations were supervised by the orthopedic medical preceptor at ISD, Kalyana Fernandes; the neurosurgeon medical preceptor Ângelo Raimundo da Silva Neto; and the orthopedic surgeon at the Children's Rehabilitation Center (CRI/RN), Tabata Alcântara. The start of the service at Anita was made possible by an agreement signed between the Santos Dumont Institute and the Rio Grande do Norte State Department of Public Health (SESAP/RN). Based on this agreement, the medication, named after the patients, is sent for storage at Anita.