5. Neurophysiological assessment of spasticity in multiple sclerosis

Abstract

Objective Spasticity is a frequent and often disabling feature of multiple sclerosis (MS). Up to 80–85% of MS cases suffer from different levels of spasticity. Appropriate management of spasticity is therefore an important part of the patient’s care. Muscle hypertonia is generally easy to recognize clinically, quantifying it is quite a complex matter. Correlation between the clinical and neurophysiological measures makes it especially difficult. The aim of the study is to review the main methods of evaluating spasticity published in the scientific literature with stress on our own experience. Methods In this session we will present neurophysiological tests used in assessment of spasticity with a special stress on the comparison of commonly used Modified Ashworth Scales scores (MAS), H-reflex testing, cutaneous and cortical silent periods, and brainstem reflexes. The main treatment options of pharmacological and non-pharmacological approaches will be discussed. Results Oral antispastic medication, therapeutic exercise and physical modalities are commonly used. From a pharmacological perspective of spasticity treatment, it is strongly recommended to use local chemodenervation with botulinum toxin for intramuscular administration under the EMG guidance. A modern approach to treat generalised spasticity is a continuous intrathecal baclofen (ITB) administration directly into the cerebrospinal fluid under neurophysiological monitoring. Conclusion Adequate evaluation and management of spasticity requires multidisciplinary approach and the setting of realistic goals that need to be achieved on an individual level, with regard to every single patient’s needs. Different options for spasticity management are available, however, choice of treatment hinges on a combination of the extent of symptoms, patient preference, and availability of services. Supported by Research Project of Charles University PRVOUK P34, Czech Republic.