Abstract
Severe spasticity is a frequent and disabling complication in patients presenting disorders of consciousness (DOC) that hinders their rehabilitative process, and is strongly correlated with pain reducing patients’ quality of life. In these patients, abnormal postures may occur as an expression of severe brain damage. Here we present the case of a 52-year-old man in decorticate rigidity following a hypoxic–ischemic encephalopathy due to myocardial infarction who showed improvement of spasticity of upper limbs following intake of levetiracetam combined with the conventional neurorehabilitation program.
Highlights
The improvements in post-resuscitation care over the recent decades have significantly given rise to an increase in patients presenting disorders of consciousness (DOC)
While this syndrome and its management are well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, there are no guidelines regarding its appropriate management in DOC patients (Martens et al, 2017)
The improvements in the upper limbs were poor: in particular, the elbows remained in a flexed position allowing only a 10-degree passive extension bilaterally, the wrists were flexed at 90◦ and the shoulders adducted with a Modified Ashworth Scale (MAS) score equal to 4
Summary
The improvements in post-resuscitation care over the recent decades have significantly given rise to an increase in patients presenting disorders of consciousness (DOC). The improvements in the upper limbs were poor: in particular, the elbows remained in a flexed position allowing only a 10-degree passive extension bilaterally, the wrists were flexed at 90◦ and the shoulders adducted with a MAS score equal to 4. An improvement in spasticity of the upper limbs was observed by the physiotherapist who was treating the patient on routinely administration of the MAS: its score reduced to three for shoulders and two for elbows and wrists. This improvement was confirmed on administration of the MAS in the following days the patient remained in vegetative/unresponsive wakefulness syndrome (CRS-r total score was 4/23). The improvement in spasticity of the upper limbs was still persisting without further changes of the oral administered antispastic and antiepileptic therapy (Figure 1)
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