The best knowledge of the pathophysiology of the main syndromes affecting motor control, the development of effective, reliable and safe technologies and therapeutic methods and the existence of drugs with therapeutic capacity for symptomatic control and/or neuroprotection have allowed the development of treatments combined that allow, by enhancing their effects through simultaneous and harmonious use, to optimize the control of the symptoms and evolutionary complications of most of the neurological diseases that are characterized due to Parkinsonian manifestations.
A comprehensive evaluation, including confirmation or modification of the diagnosis with evaluation of the aggravating factors and the evolutionary profile together with the individualization of the patient's functional commitment, allows us to design a more effective and tolerable therapeutic strategy for neurological restoration or rehabilitation, which It usually includes modification of the pharmacological regimen, hygienic-dietary measures, specialized motor training and multi-disciplinary. If surgical treatment is applied using stereotactic functional surgery techniques, a high degree of recovery of motor abilities and functional independence of the individual.
The own development of these neurological restoration or rehabilitation methods and technologies and the controlled introduction of other restorative therapeutic agents or rheurological rehabilitation have allowed the conception and validation of this comprehensive care program, applied by a qualified work team of the CIREN International Center for Neurological Restoration for more than 10 years. With this it is possible to achieve high recovery rates and a significant improvement in quality of life in more than 90% of patients more than 1000 patients treated with this technology.
The program includes an evaluation week during which a set of exams is carried out in the clinic specialized in parkinsonian syndrome. It consists of a general clinical evaluation of the patient's health status, a quantification by international scales to measure neurological condition, motor capacity, functional capacity and quality of life, neurophysiological studies specialized in exploration of the motor system and motor integration perceptual, structural and functional imaging studies using computed axial tomography techniques, resonance nuclear magnetic, single photonic emission, or ultrasound techniques that correlate with the findings clinical symptoms and the intensity of the motor commitment.
This evaluation is complemented by a functional evaluation of the kinetics of movement and gait, studies spirometric, stabilometric, neuropsychological and the application of international instruments to determine the degree of disability or objectify the neurological defect to be modified.
The information obtained by this comprehensive evaluation is analyzed collectively by specialists from various disciplines and is designs a unique neurological restoration or rehabilitation program in stages, with objectives specific measures that are set according to the patient's capabilities and previously accumulated experience.
The Neurological Restoration or Rehabilitation Program is executed in 4-week therapeutic cycles (28 days) which includes hygienic-dietary measures to improve general condition, pharmacokinetic disorders and the nutritional status of the patient, pharmacological adjustment to control mobility fluctuations and other complications developmental motor and non-motor activities using as an instrument a time diary designed in our clinic to optimize thedose and frequency of administration of medications to be prescribed and their periodic adjustment until sufficient control is achieved symptomatic and stability of the motor condition throughout the day. At the same time, disorders of the sleep, appetite, blood pressure and other autonomic or mental alterations that usually coexist with progression of the disease or as a side effect of some drugs.
A comprehensive neurological restoration or rehabilitation program is also developed that includes training of posture, gait and balance, training of manipulative skills with language training and techniques of learning, using feedback methods, specific motor learning, strengthening techniques and/or stretching and more efficient specific purpose training systems to stimulate abilities neuroplastics with the comprehensive objective of adapting the pattern of motor behavior and increasing the motor capabilities of the patient. individual especially for the execution of daily tasks.
In the presence of refractory symptoms or manifestations, severe gait disorders with blockages, freezing or falls, the presence of disabling and annoying dyskinesias or the need for high doses of medications, which cause significant adverse effects for the control of the cardinal symptoms of the disease, the possibility of surgical treatment by stereotactic functional surgery techniques, in which case a procedure will be performed. first The surgical procedure will be carried out with prior written informed consent from the patient and then the procedures will be carried out. other therapeutic measures.
In the case of surgery, a minimum of 10 days is required after the evaluation for the execution of the procedure and control of the result.
If the comprehensive care program is applied, as many four-week cycles will be required as the evaluation. determine, the most common being the application of one or two therapeutic cycles annually.
In an open clinical trial it was determined that the effectiveness of the restoration or rehabilitation program comprehensive neurological care is 93% and the ranges of improvement obtained for motor capacity are approximately 20% and for functional capacity approximately 35%. In more than 1000 patients treated to date, no have observed complications, accidents or adverse events that compromise life or leave consequences. The rate of adverse effects or transient complications is less than 5%.
Surgical treatment has variable effectiveness and specific indications. The Vim Thalamototomy induces more 90% suppression of tremor in contralateral extremities without residuals and approximately 20% overall improvement of parkinsonism.
Posteroventral pallidotomy induces suppression of contralateral dyskinesias in more than 95% of patients and an overall improvement of 35 and 40%. Bilateral lesion of the subthalamic nucleus resolves blocks and other gait disorders in more than 90% of the operated patients, with an overall improvement of approximately 60%. The effects after surgery are maintained with little modification until at least 5 years, in most patients.
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