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(Adnkronos Salute) - Trattare gli spasmi associati a lesioni cerebrospinali con la radiochirurgia stereotassica, una forma di radioterapia precisa come un bisturi, che abbina efficacia e sicurezza. Il primo centro al mondo a proporla come trattamento innovativo sperimentale per le complicanze di un danno cerebrale-spinale è l'Irccs Sacro Cuore Don Calabria di Negrar, in provincia di Verona. "Nel 2022 abbiamo trattato 4 pazienti affetti da spasticità con uso della radiochirurgia stereotassica, ottenendo risultati importanti con una riduzione o risoluzione della spasticità e nessuna tossicità correlata al trattamento, come riportato in uno studio pubblicato su 'Radiotherapy and Oncology' - spiega Luca Nicosia, radioterapista oncologo dell'istituto - Gli esiti positivi raggiunti ci hanno portato ad avviare l'attuale sperimentazione che prevede di arruolare 10 pazienti adulti, affetti da spasticità diffusa e non trattabile con le terapie tradizionali". Sono circa 100 milioni le persone nel mondo che convivono con le conseguenze di patologie cerebrospinali o di traumi al cervello e al midollo a seguito di incidenti, ricordano dall'Irccs veronese. Tra queste, la spasticità e il dolore correlato sono una complicanza comune e debilitante a lungo termine. Si stima che colpisca il 65-78% dei pazienti con lesioni croniche del midollo spinale e il 25% di chi ha avuto un ictus grave. Ad oggi i trattamenti convenzionali prevedono interventi chirurgici invasivi, come l'uso di pompe di baclofene che devono essere inserite nella cavità addominale per erogare il farmaco dall'interno, o il ricorso alla rizotomia dorsale selettiva, una tecnica neurochirurgica che consiste nell'interruzione della connessione tra alcuni nervi e il midollo spinale. Sono possibili anche trattamenti per via orale, meno invasivi, ma anche questi hanno efficacia limitata e sono spesso accompagnati da effetti collaterali indesiderati.I ricercatori di Negrar hanno invece definito "un nuovo protocollo sperimentale per il trattamento non invasivo, più conservativo e a bassa tossicità della spasticità per mezzo della radiochirurgia stereotassica - riporta una nota - che prevede l'impiego della radioterapia per agire sui nervi spinali selezionati bloccando la conduzione elettrica responsabile degli spasmi"."La spasticità è una condizione caratterizzata da un aumento eccessivo e anomalo del tono muscolare - descrive Elena Rossato, direttore del Servizio di Medicina fisica e Riabilitazione dell'Irccs di Negrar - In particolare, consiste in spasmi di uno solo o di più muscoli scheletrici che possono provocare rigidità durante il movimento con disagio o dolore e difficoltà motorie ai 4 arti, nella respirazione e nel riposo notturno. La spasticità ha quindi un grande impatto negativo sulla qualità di vita dei pazienti e interferisce fortemente con la loro capacità di compiere attività quotidiane come ad esempio il trasferimento dalla sedia a rotelle. Per questo motivo la spasticità ha diverse conseguenze sociali e riabilitative, con un alto tasso di procedure infermieristiche, ricoveri ospedalieri e costi". "Quello che è stato avviato all'Irccs di Negrar - illustra Nicosia - è un protocollo che prevede l'utilizzo della radiochirurgia stereotassica per trattare pazienti affetti da spasmi invalidanti. I trattamenti ad oggi disponibili per questa condizione prevedono l'utilizzo di farmaci, gravati da effetti collaterali e da una progressiva perdita di efficacia, o interventi chirurgici che, oltre a richiedere una specifica competenza, sottopongono pazienti molto fragili a operazioni importanti con potenziali conseguenze debilitanti. L'infusore di baclofene richiede, ad esempio, un intervento che potrebbe esporre i pazienti a complicazioni, inoltre deve essere ricaricato periodicamente e può essere soggetto a infezioni. In aggiunta a ciò, i pazienti potrebbero diventare progressivamente resistenti al trattamento. Altre terapie come l'iniezione della tossina botulinica intramuscolare o le iniezioni perineurali di alcol sono limitate nella dose e devono essere ripetute nel tempo, mentre soluzioni come la neurolisi chirurgica, le neurotomie selettive e le rizotomie sono caratterizzate da sessioni chirurgiche prolungate, complicazioni e richiedono un'équipe esperta". "La radiochirurgia stereotassica - sottolinea lo specialista - rappresenta invece un'opzione non invasiva e con un'elevata precisione, che prevede una singola seduta di trattamento della durata di 40 minuti. Il trattamento è definitivo sulle sedi trattate e ha la capacità di ridurre o eliminare la spasticità. Il trattamento può essere ripetuto, ma solo su altre sedi"."La radiochirurgia stereotassica è tipicamente utilizzata per intervenire su tumori solidi primari e metastatici, e per il trattamento di malattie non oncologiche come l'oftalmopatia di Graves, le aritmie cardiache e la nevralgia del trigemino", evidenzia Nicosia. "Il nostro - precisa - è il primo centro al mondo a proporre questo trattamento innovativo" per la spasticità da lesioni cerebrospinali, "all'interno di un progetto di ricerca multidisciplinare che coinvolge oltre alla radioterapia oncologica anche la fisiatria, la neurologia e l'anestesia per provarne l'efficacia". "L'obiettivo primario dello studio" in corso, conclude Rossato, "sarà quello di stimare la riduzione della frequenza e dell'intensità degli spasmi dopo il trattamento, monitorandole a 1, 3, 6 e 12 mesi dopo la radiochirurgia stereotassica. Tra gli obiettivi secondari, inoltre, ci saranno anche quelli di valutare la tossicità acuta e tardiva e il tasso di ricaduta della spasticità, e descrivere la variazione nella qualità di vita del paziente dopo il trattamento e il miglioramento del carico di lavoro dei caregiver". di Adnkronos   09-08-2024 - 12:31 Link copiato Commenti Leggi la Netiquette

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