[Treatment of neurogenic heterotopic ossifications (NHO) in brain injured patients: review of literature].
This article is a review of the literature about treatment of neurogenic heterotopic ossifications (NHO) in brain injured patients, from analysis of the main data bases (Medline, Embase, Reedoc). In spite of the hope they arouse in the seventies, biphosphonates, including etidronate, have not demonstrated their efficiency to inhibit NHO in clinical practice. In fact a very early diagnosis, with the scintigraphic overactivity of the joint area and the increase of serum alkaline phosphatases, must lead to begin passive motion and postures, and may contribute to save functional range of motion. Yet, when joint stiffness or even ankylosis have led to severe functional disorders, surgery with NHO resection is the only way; it looks more reliable to manage it when NHO is mature, after a delay of more than 12 months after the first signs, but earlier operations have been reported without an enhanced risk of recurrence; this surgery must be associated with continuous passive motion for several weeks; radiation therapy and/or non-steroid anti-inflammatory drugs have been proposed in the immediate after-surgery period, but their role is still discussed.
Pélissier
J
J
Unité de rééducation et réadaptation neurologique, CHU Montpellier-Nîmes, centre médical, 30240, Le Grau du Roi, France. jacques.pelissier@chu-nimes.fr
Petiot
S
S
Bénaïm
C
C
Asencio
G
G
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications*; D003937:Diagnosis, Differential; D006801:Humans; D009999:Ossification, Heterotopic / Q000188:drug therapy* / Q000601:surgery; D026741:Physical Therapy Modalities; D011379:Prognosis; D011878:Radiotherapy; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal