Diretrizes da Academia Brasileira de Neurologia para reabilitação do acidente vascular cerebral: parte I

Minelli, Cesar; Bazan, Rodrigo; Pedatella, Marco Túlio Araújo; Neves, Luciana de Oliveira; Cacho, Roberta de Oliveira; Magalhães, Sheila Cristina Sayuri Abe; Luvizutto, Gustavo José; Moro, Carla Heloísa Cabral; Lange, Marcos Christiano; Modolo, Gabriel Pinheiro; Lopes, Bruna Correia; Pinheiro, Elisandra Leites; Souza, Juli Thomaz de; Rodrigues, Guilherme Riccioppo; Fabio, Soraia Ramos Cabette; Prado, Gilmar Fernandes do; Carlos, Karla; Teixeira, Juliana Junqueira Marques; Barreira, Clara Monteiro Antunes; Castro, Rodrigo de Souza; Quinan, Thalita Dayrell Leite; Damasceno, Eduardo; Almeida, Kelson James; Pontes-Neto, Octávio Marques; Dalio, Marina Teixeira Ramalho Pereira; Camilo, Millene Rodrigues; Tosin, Michelle Hyczy de Siqueira; Oliveira, Bianca Campos; Oliveira, Beatriz Guitton Renaud Baptista de; Carvalho, João José Freitas de; Martins, Sheila Cristina Ouriques

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BRAZILIAN ACADEMY OF NEUROLOGY • Arq. Neuro-Psiquiatr. 80 (6) • Jun 2022 • https://doi.org/10.1590/0004-282X-ANP-2021-0354 copiar

Diretrizes da Academia Brasileira de Neurologia para reabilitação do acidente vascular cerebral: parte I

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

As Diretrizes Brasileiras para Reabilitação do AVC são fruto de um esforço conjunto do Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia com o objetivo de orientar os profissionais envolvidos no processo de reabilitação para a redução da incapacidade funcional e aumento da autonomia dos indivíduos. Membros do grupo acima participaram de fóruns de discussão na web com pré-temas, seguidos de reuniões por videoconferência em que as controvérsias foram discutidas, levando a um consenso. Essas diretrizes, divididas em duas partes, focam as implicações de recentes ensaios clínicos, revisões sistemáticas e metanálises sobre reabilitação do AVC. O objetivo principal é servir de orientação a médicos, fisioterapeutas, fonoaudiólogos, terapeutas ocupacionais, enfermeiros, nutricionistas e demais profissionais envolvidos no cuidado pós-AVC. As recomendações e níveis de evidência foram adaptados de acordo com a literatura disponível atualmente. Aqui é apresentada a Parte I sobre tópicos de reabilitação na fase aguda, prevenção e tratamento de doenças e comorbidades frequentes após o AVC.

Palavras-chave:
Acidente Vascular Cerebral; Guia; Reabilitação Neurológica; Guias de Prática Clínica como Assunto

Comorbidities	Drug	Daily dose	Duration of study follow-up	Adverse effects
Central Pain	Amitriptyline3939. Kim JS. Pharmacological management of central post-stroke pain: a practical guide. CNS Drugs. 2014 Sep;28(9):787-97. https://doi.org/10.1007/s40263-014-0194-y https://doi.org/10.1007/s40263-014-0194-...	Start with 25 mg, up to 75 mg	4 weeks	Dry mouth, urinary retention, drowsiness, and confusion
	Lamotrigine3939. Kim JS. Pharmacological management of central post-stroke pain: a practical guide. CNS Drugs. 2014 Sep;28(9):787-97. https://doi.org/10.1007/s40263-014-0194-y https://doi.org/10.1007/s40263-014-0194-...	Start with 25 mg, up to 200 mg	8 weeks	Rash and severe headache
	Duloxetine4242. Kim NY, Lee SC, Kim YW. Effect of duloxetine for the treatment of chronic central poststroke pain. Clin Neuropharmacol. 2019 May-Jun;42(3):73-6. https://doi.org/10.1097/WNF.0000000000000330 https://doi.org/10.1097/WNF.000000000000...	Start with 30 mg, up to 60 mg	3 weeks	Nausea, agitation, and drowsiness
	Pregabalin4343. Kim JS, Bashford G, Murphy TK, Martin A, Dror V, Cheung R. Safety and Efficacy of pregabalin in patients with central post-stroke pain. Pain. 2011 May;152(5):1018-23. https://doi.org/10.1016/j.pain.2010.12.023 https://doi.org/10.1016/j.pain.2010.12.0...	Start with 150 mg, up to 600 mg	12 weeks	Somnolence, and peripheral edema
	Gabapentin3939. Kim JS. Pharmacological management of central post-stroke pain: a practical guide. CNS Drugs. 2014 Sep;28(9):787-97. https://doi.org/10.1007/s40263-014-0194-y https://doi.org/10.1007/s40263-014-0194-...	Start with 900 mg, up to 2400 mg	8 weeks	Dizziness and drowsiness
	Fluvoxamine4444. Shimodozono M, Kawahira K, Kamishita T, Ogata A, Tohgo S, Tanaka N. Reduction of central poststroke pain with the selective serotonin reuptake inhibitor fluvoxamine. Int J Neurosci. 2002 Oct;112(10):1173-81. https://doi.org/10.1080/00207450290026139 https://doi.org/10.1080/0020745029002613...	Start with 50 mg, up to 125 mg	2 to 4 weeks	Drowsiness, insomnia, and restlessness
Mood disorder	Nortriptyline7979. Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016 Mar 1;173(3):221-31. https://doi.org/10.1176/appi.ajp.2015.15030363 https://doi.org/10.1176/appi.ajp.2015.15...	Start with 25 mg, up to 100 mg	6 weeks	Dry mouth, urinary retention, drowsiness, and confusion
	Trazodone7979. Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016 Mar 1;173(3):221-31. https://doi.org/10.1176/appi.ajp.2015.15030363 https://doi.org/10.1176/appi.ajp.2015.15...	Start with 25 mg, up to 200 mg	32 days	Dry mouth, urinary retention, drowsiness, and confusion
	Citalopram7979. Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016 Mar 1;173(3):221-31. https://doi.org/10.1176/appi.ajp.2015.15030363 https://doi.org/10.1176/appi.ajp.2015.15...	Start with 5 mg, up to 10 mg	6 weeks	Nausea, drowsiness, weakness, dizziness, anxiety, trouble sleeping, and sexual dysfunction
	Fluoxetine7979. Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016 Mar 1;173(3):221-31. https://doi.org/10.1176/appi.ajp.2015.15030363 https://doi.org/10.1176/appi.ajp.2015.15...	Start with 10 mg, up to 10 mg	6 weeks to 3 months	Nausea headaches, insomnia, diarrhea, weakness, and anxiety
	Reboxetine7979. Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016 Mar 1;173(3):221-31. https://doi.org/10.1176/appi.ajp.2015.15030363 https://doi.org/10.1176/appi.ajp.2015.15...	4 mg	16 weeks	Dry mouth, constipation, and sexual dysfunction
Sleep disorders	Trazodone110110. Chen C-Y, Chen C-L, Yu C-C. Trazodone improves obstructive sleep apnea after ischemic stroke: a randomized, double-blind, placebo-controlled, crossover pilot study. Neurol. 2021 Feb 24;268(8):2951-60. https://doi.org/10.1007/s00415-021-10480-2 https://doi.org/10.1007/s00415-021-10480...	100 mg	1 week	Dry mouth, urinary retention, somnolence, and confusion
Epilepsy	Levetiracetam157157. Brigo F, Lattanzi S, Zelano J, Bragazzi NL, Belcastro V, Nardone R, et al. Randomized controlled trials of antiepileptic drugs for the treatment of post-stroke seizures: a systematic review with network meta-analysis. Seizure. 2018 Oct 1;61:P57-62. https://doi.org/10.1016/j.seizure.2018.08.001 https://doi.org/10.1016/j.seizure.2018.0...	Start with 500 mg up to 300 mg	52 weeks	Fatigue, drowsiness, skin eruptions or allergies
	Lamotrigine157157. Brigo F, Lattanzi S, Zelano J, Bragazzi NL, Belcastro V, Nardone R, et al. Randomized controlled trials of antiepileptic drugs for the treatment of post-stroke seizures: a systematic review with network meta-analysis. Seizure. 2018 Oct 1;61:P57-62. https://doi.org/10.1016/j.seizure.2018.08.001 https://doi.org/10.1016/j.seizure.2018.0...	Start with 25 mg up to 200 mg	52 weeks	Dizziness and rash
	Controlled release carbamazepine157157. Brigo F, Lattanzi S, Zelano J, Bragazzi NL, Belcastro V, Nardone R, et al. Randomized controlled trials of antiepileptic drugs for the treatment of post-stroke seizures: a systematic review with network meta-analysis. Seizure. 2018 Oct 1;61:P57-62. https://doi.org/10.1016/j.seizure.2018.08.001 https://doi.org/10.1016/j.seizure.2018.0...	Start with 200 mg up to 1600 mg	52 weeks	Confusion, skin eruptions or allergies, nausea, and vomiting

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[1] Correspondence:
Cesar Minelli; Email: cdminelli@yahoo.com.br.