Mechanisms of Spasticity and its Assessment


Authors: I. Štětkářová
Published in: Cesk Slov Neurol N 2013; 76/109(3): 267-280
Category: Minimonography

Overview

Spasticity is one of the complex motor system disorders and is a sign of central motor neuron disorder caused by trauma, ischemia or haemorrhage, inflammation, degenerative process or tumour. Spasticity is a symptom associated with a lesion within the central motor neuron. In addition to increased muscle activity, muscle contraction and paresis also occurs. Voluntary movement is associated with co-contractions and synkinesis, adversely affecting dexterity and muscle strength. Flexor and extensor spasms also have a negative effect. There are two types of spasticity: cerebral and spinal. Cerebral lesions occur either above the level of brainstem or at the level of brainstem. Due to these lesions, cerebral cortex looses its control over the inhibitory structures of the brainstem. Spinal lesions lead to severe spastic dystonia with predominant involvement of flexors. An objective examination is required to assess the type and degree of spasticity. An objective examination should be performed at the start of treatment and it is the main parameter determining further management. Routine clinical practice mainly relies on clinical evaluation scales. Neurophysiological, physical and biochemical methods are used less frequently and mainly at specialised centres. Rather than complete amelioration of spasticity, the aim of treatment is to alleviate its negative effects on activities that limit the patient. Achievable aims should be set by the patient and the physician at the initiation of treatment. Rehabilitation has a crucial role in the treatment of patients with spasticity. Pharmacotherapy is used, also due to uncomplicated application. Owing to its high efficacy and low incidence of adverse effects, botulinum toxin has an exclusive place in the treatment of focal spasticity. Administration of baclofen via intrathecal pump systems has been proven as highly effective in patients with severe generalized spasticity. New technologies and new treatment modalities, including advanced use of robots, are being developed.

Key words:
spasticity – pathophysiological mechanisms – central motor neuron syndrome – evaluation of spasticity – rehabilitation – botulinum toxin – intrathecal baclofen


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