Treatment Of Spasticity In Patients Research Articles

Treatment of Spasticity in Patients After Brain Injury

Treatment of Spasticity in Patients After Brain Injury

Selective Dorsal Rhizotomy in Treatment of Spasticity in Patients with Cerebral Palsy

Selective dorsal rhizotomy (SDR) is effective and safe neurosurgical method for the treatment of patients with spastic forms of cerebral palsy (CP). The aim of the review is to introduce the opportunities of SDR in CP patients, to present indications, contraindications, and current inclusion criteria for the surgery for the broad audience of specialists. Authors have given recommendations on SDR implementation in complex rehabilitation of CP patients and have defined its effective combination with other methods of spasticity treatment according to the international experience of SDR, and its short-term and long-term results. The particular attention was paid to the application of SDR in cases of secondary orthopaedic deformities due to CP. The understanding of opportunities and limitations of SDR will allow us to give the patients relevant help and use the advantages of this method.

Treatment of spasticity in patients with the consequences of traumatic brain injury

Up to 16–20% of patients with a history of traumatic brain injury (TBI), regardless of its severity, suffer from pronounced spasticity, cognitive, vestibular and motor disorders. At the same time, data on the effectiveness of botulinum neurotoxin (BoNT) in the treatment of post-traumatic spasticity is lacking.Objective: to assess the effectiveness of peripheral myorelaxants (botulinum neurotoxin type A) in the treatment of past-traumatic spasticity.Patients and methods. 21 male patients aged 25 to 48 years with post-traumatic spastic hemiparesis (at least 6 months after the injury) were examined. 450 to 850 U (mean – 650 U) of BoNT (incobotulinumtoxin) was injected into the spastic muscles of the upper and lower extremities. The follow-up assessment of spasticity and paresis was performed 24±3 days after BoNT injection. Patterns of spasticity were studied: shoulder adduction, elbow joint flexion, forearm pronation, hand and finger flexion, hip adduction, shin flexion, foot flexion, toe flexion. The following methods were used: original methods of manual testing (MMT) of spasticity, Tardieu scale (TS), modified Ashworth scale (MAS), Medical Research Council Scale (MRCS) to assess paresis.Results and discussion. 24±3 days after incobotulotoxin administration, we observed a significant 1.5–2-fold decrease in spasticity angle (xS) and a reduction in the angle of neuromuscular reactivity (xV3) by 15–30° in all the studied patterns. Changes of xV1 (muscle extensibility) and xA (muscle strength) were not significant. No adverse reactions were observed. The use of MMT and TS has shown its effectiveness and specificity in the evaluation of spasticity and effectiveness of BoNT, and in the dynamics of muscle condition.Conclusion. The study showed the feasibility of using MMT and TS in the evaluation and assessment of spasticity, as well as the effectiveness and safety of incobotulinumtoxin (Xeomin) in dosages from 450 to 850 U in the treatment of spasticity of the upper and lower extremities in patients with the consequences of TBI.

До питання про ефективність препарату Мускомед у пацієнтів із постінсультною спастичністю

Стаття присвячена лікуванню пацієнтів, які перенесли ішемічний інсульт. Зокрема, робиться акцент на терапії постінсультної спастичності. Наведено дані дослідження клінічної ефективності та безпеки препарату Мускомед у лікуванні спастичності в пацієнтів у відновному періоді ішемічного мозкового інсульту.

Arbaclofen Extended-Release Tablets for the Treatment of Spasticity in Patients with Multiple Sclerosis: An Open-Label Extension Study

Arbaclofen Extended-Release Tablets for the Treatment of Spasticity in Patients with Multiple Sclerosis: An Open-Label Extension Study

Arbaclofen Extended-Release Tablets for the Treatment of Spasticity in Patients with Multiple Sclerosis: A Randomized, Placebo-Controlled Clinical Trial

Arbaclofen Extended-Release Tablets for the Treatment of Spasticity in Patients with Multiple Sclerosis: A Randomized, Placebo-Controlled Clinical Trial

Evaluation of the Effect of Intranasal Lidocaine in the Treatment of Spasticity in Patients with Traumatic Brain Injury.

BackgroundSpasticity following traumatic brain injury (TBI) is one of the most significant barriers of returning patients to their normal life. Spasticity caused by TBI does not have a specific or definitive treatment, and the clinical effect of pharmacologic treatments has not been significant.MethodsIn this single-arm study, we evaluated 15 patients. For each patient with spasticity, treatment with oral baclofen 25 mg was started three times a day as a part of standard therapy. After 48 hours, if the spasticity did not decrease by at least one score in the Modified Tardieu or Ashworth scales, lidocaine 0.5% was administered as a continuous intranasal infusion. The initial dose of lidocaine was 1 mg/min, which was gradually increased to 2 mg/min. Spasticity and the frequency of spasms were assessed by Ashworth and modified tardieu scales (MTS) and Spasm Frequency Score (SFS), respectively. Heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MAP), Richmond Agitation-Sedation Scale (RASS), Glasgow Coma Scale (GCS), and arterial oxygen saturation (SPo2) of patients were recorded during nine days of treatment. All data were analyzed by SPSS version 21. P-value less than 0.05 was considered as statistically significant.ResultsOut of 15 participants in this study, 13 (86.7%) were male, and 2 (13.3%) were female (mean age: 29.26 ± 12.5 years). There were no significant differences in Ashworth Scale, Modified Tradieu Scale, RASS Score, GCS Score, MAP, SPo2 percentage, HR, RR, and the number of spasms per day between the time of initiation of treatment and the second day of baclofen treatment (P > 0.05). Evaluation of spasticity using Ashworth scale on the first and last days of lidocaine treatment showed a significant decrease in the mean spasticity (3.46 ± 0.51 and 1.46 ± 0.91, respectively; P < 0.001). Spasticity assessment using the MTS showed a significant reduction in the mean of the last day of treatment compared to the mean of the first day of treatment (3.6 ± 0.5 and 1.26 ± 0.51, respectively; P < 0.001). This decrease was also seen in the mean of the last day of treatment compared to the first day in SFS (13.3 ± 3.88 and 3.8 ± 0.51, respectively; P < 0.001). Comparison of HR, RR, MAP, RASS, GCS, and SPo2 on the first and last days of treatment did not show any statistical differences.ConclusionsAlthough continuous intranasal treatment with lidocaine can be effective in spasm reduction of patients with TBI, further studies with larger sample sizes and longer follow-up periods are required.

Influence of Visual Stimulation-Induced Passive Reproduction of Motor Images in the Brain on Motor Paralysis After Stroke.

Finger flexor spasticity, which is commonly observed among patients with stroke, disrupts finger extension movement, consequently influencing not only upper limb function in daily life but also the outcomes of upper limb therapeutic exercise. Kinesthetic illusion induced by visual stimulation (KINVIS) has been proposed as a potential treatment for spasticity in patients with stroke. However, it remains unclear whether KINVIS intervention alone could improve finger flexor spasticity and finger extension movements without other intervention modalities. Therefore, the current study investigated the effects of a single KINVIS session on finger flexor spasticity, including its underlying neurophysiological mechanisms, and finger extension movements. To this end, 14 patients who experienced their first episode of stroke participated in this study. A computer screen placed over the patient’s forearm displayed a pre-recorded mirror image video of the patient’s non-paretic hand performing flexion–extension movements during KINVIS. The position and size of the artificial hand were adjusted appropriately to create a perception that the artificial hand was the patient’s own. Before and after the 20-min intervention, Modified Ashworth Scale (MAS) scores and active range of finger extension movements of the paretic hand were determined. Accordingly, MAS scores and active metacarpophalangeal joint extension range of motion improved significantly after the intervention. Moreover, additional experimentation was performed using F-waves on eight patients whose spasticity was reduced by KINVIS to determine whether the same intervention also decreased spinal excitability. Our results showed no change in F-wave amplitude and persistence after the intervention. These results demonstrate the potential clinical significance of KINVIS as a novel intervention for improving finger flexor spasticity and extension movements, one of the most significant impairments among patients with stroke. The decrease in finger flexor spasticity following KINVIS may be attributed to neurophysiological changes not detectable by the F-wave, such as changes in presynaptic inhibition of Ia afferents. Further studies are certainly needed to determine the long-term effects of KINVIS on finger spasticity, as well as the neurophysiological mechanisms explaining the reduction in spasticity.

Results of botulinum toxin injections for the treatment of spasticity in patients with primary lateral sclerosis

Results of botulinum toxin injections for the treatment of spasticity in patients with primary lateral sclerosis

Clinical evaluation and monitoring of the effect of extracorporeal shockwave therapy in sub-acute and chronic post-stroke spasticity patients

IntroductionTo evaluate the efficacy and maintenance of extracorporeal shockwave therapy (ESWT) in sub-acute and chronic post-stroke spasticity patients in the Suez Canal region.MethodsAn interrupted time series study was conducted; 82 patients were recruited in accordance with the defined inclusion and exclusion criteria. They were divided into 2 subgroups depending on the stroke duration: a sub-acute group (35 patients) and a chronic group (47 patients). ESWT was applied over knee and ankle flexor muscle belly with the following setup parameters: energy: 0.068–0.093 mJ/mm; frequency: 5 Hz; number of shots: 1500. Modified Ashworth score, clonus score, 3-minute walk test, range of motion angle of both knee and ankle joint, and Fugl-Meyer Assessment were established at baseline, after the 1&lt;sup&gt;st&lt;/sup&gt; session, and at the 1&lt;sup&gt;st&lt;/sup&gt;, 4&lt;sup&gt;th&lt;/sup&gt;, and 8&lt;sup&gt;th&lt;/sup&gt; week for the 2 groups.ResultsRegarding the sub-acute group, there was a statistically significant improvement in the modified Ashworth score, clonus score, 3-minute walk test, and range of motion angle of both knee and ankle joint after the 1&lt;sup&gt;st&lt;/sup&gt; session and after the 1&lt;sup&gt;st&lt;/sup&gt; week of intervention. The differences were not statistically significant after 4&lt;sup&gt;th&lt;/sup&gt; or 8&lt;sup&gt;th&lt;/sup&gt; week. The chronic group showed no statistically significant improvement after the 1&lt;sup&gt;st&lt;/sup&gt; session or in the 1&lt;sup&gt;st&lt;/sup&gt;, 4&lt;sup&gt;th&lt;/sup&gt;, or 8&lt;sup&gt;th&lt;/sup&gt; week assessment.ConclusionsESWT was more effective in treatment of spasticity in patients with sub-acute stroke compared with those with chronic stroke.

Rehabilitation of patients with multiple sclerosis

Multiple sclerosis is a common cause of disability among young and middle-aged people. Despite the modern possibilities of diagnostics and therapy, over time, the disease acquires a secondary progressive character. Rehabilitation of patients at all stages of the disease plays an important role in improving well-being, improving the quality of life, adapting the patient and restoring motor skills. However, there is currently no clear recommendation for the application of specific techniques in each case. The aim of this work was to analyze the available methods of rehabilitation therapy, to highlight the most used and promising ones. Due to the progressive course of the disease, the benefits of rehabilitation measures are usually higher at the initial stages. Nevertheless, nowadays there is a large number of works devoted to rehabilitation measures in patients with moderate and high levels of disability. It has been shown that both inpatient and outpatient rehabilitation has a positive effect on the quality of life and improvement of clinical indicators. Our review describes the main techniques with recommendations for the scheme of application. A comprehensive assessment of the patient's health status, a multidisciplinary team and a personalized approach increase the quality and effectiveness of rehabilitation measures. We also describe our own experience in the treatment of spasticity in patients with a secondary progressive multiple sclerosis.

Adaptive neuromodulation in the treatment of spasticity

This research has the purpose to evaluate the immediate effects on spasticity of lower limbs of a single session of two different therapeutic approaches in patients affected by cerebral palsy. A total of 30 patients, with an age between and 10-40 years old and affected by cerebral palsy associated to spastic para/tetra paresis, were recruited and equally and randomly divided into 3 groups: group A has was treated with hydrokinesitherapy (HKT). Group B was treated with adaptive electro neuromodulation (ENM). Group C underwent a sham approach respecting the operative procedure of Group B with the device not operating. All patients were evaluated, before (T0) and after (T1) the single session of treatment, through myometric evaluation of muscular rheological parameters. The analysis of results underlined that both HKT and ENM resulted effective in reducing muscu-lar hypertone associated to spasticity, while in Group C no significant results were detected. We can affirm that both ENM and HKT approach can be good alternatives for the treatment of spasticity in patients affected by cerebral palsy.

Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke.

Extracorporeal shock wave therapy (ESWT) has been suggested as a useful treatment for spasticity in patients with stroke. To date, most studies have used clinical or biomechanical assessments to determine the effects of treatment. To assess the effect of a single session of ESWT through ultrasonographic assessment on spasticity in patients with chronic stroke. Randomized controlled trial. Rehabilitation center. Eighteen patients with chronic stroke. Participants were randomly assigned to an ESWT group (n = 9) or control group (n = 9). In the ESWT group, a single session of ESWT was given in the medial head of the gastrocnemius muscle of the spastic side at 4 Hz, 2000 shots with intensity of stimulation using energy of 0.1 mJ/mm2 . Sham stimulation was provided by only making sound without putting the device into contact with the skin in the control group. The clinical trial registration number of this study is KCT0002582. Participants were evaluated prior to the treatment, 30 minutes, 1 week, and 4 weeks after treatment. Clinical measures included Modified Ashworth Scale (MAS), passive range of motion (PROM), and Fugl-Meyer Assessment (FMA). As the primary outcome measure, the ultrasonographic measures were Achilles tendon length (ATL), muscle fascicle length (MFL), muscle thickness (MT), and pennation angle (PA). There were no significant differences between the 2 groups for any demographic or baseline measures. At all follow-up evaluations, improvement was shown in MAS as well as changes from baseline of ultrasonographic measures in the ESWT group compared to the control group. In the case of ultrasonographic measures, the difference between the group was greatest at 4 weeks. At follow-up of 4 weeks, between-group difference was 0.66 points (P = .04) on MAS scores, 5.45 points (P = .004) on ATL scores, 4.95 points (P = .002) on MFL scores, 1.83 points (P < .001) on MT scores, and 3.73 points (P < .001) on PA scores. Some ultrasonographic measures of spasticity as well as MAS were improved after a single session of ESWT. Future studies with larger numbers of subjects compared with other spasticity metrics are necessary to further evaluate the treatment effect of ESWT. II.

Intermittent theta-burst transcranial magnetic stimulation for the treatment of spasticity in patients with recurring multiple sclerosis: the results of a double-blind randomised clinical trial

It has been suggested that the repetitive transcranial magnetic stimulation could be useful as a non-pharmacological treatment for spasticity. The aim of this study was to evaluate the clinical and neurophysiological effects of high-frequency intermittent theta burst stimulation (iTBS) on lower limb spasticity in patients with relapsing multiple sclerosis in a randomized, double-blind placebo controlled trial. Seventeen patients in the remitting phase of the disease were randomly allocated to sham or magnetic therapy group and underwent iTBS over contralateral motor cortex of the most affected leg once a day for two weeks. Each session consisted of 10 bursts containing three pulses at 50 Hz repeated at 200 ms intervals (5 Hz) every 10 s for a total of 600 stimuli. The iTBS effect was assessed by using clinical (such as the Modified Ashworth Scale) and neuro-physiological (H/M amplitude ratio and cortical silent period duration) parameters. Two-week iTBS over motor cortex of the most affected leg did not produce any significant clinical effect on spasticity. However, it decreases the H/M amplitude ratio and increases duration of cortical silent period but not significantly, in patients with relapsing multiple sclerosis. The stimulation protocol used in this study does not have significant therapeutic effect. Therefore, we do recommend further studies as neurophysiological changes were evident.

Extracorporeal shock waves versus botulinum toxin type A in the treatment of post-stroke upper limb spasticity – A randomized, non-inferiority trial

Botulinum toxin type A (BoNT-A) is the recommended first-line treatment for regional spasticity affecting the upper limb in patients with stroke. Despite optimal treatment, BoNT-A injection might induce muscle weakness and might be associated with high cost and invasiveness. Recent studies have suggested that extracorporeal shock wave therapy (ESWT) is an effect method for the treatment of spasticity in stroke patients. The objective of this study was to investigate whether extracorporeal shock wave therapy is non-inferior to botulinum toxin type A (BoNT-A) for treatment of post-stroke upper limb spasticity. Forty-two patients with chronic stroke (28 men; mean age, 61.0 ± 10.6 years) were randomly assigned to receive either ESWT or BoNT-A. During the study period, all patients continued their regular rehabilitation. Assessments were performed at baseline and at one, four, and eight weeks after the intervention. The outcome was the change from baseline of the Modified Ashworth Scale (MAS) at the wrist flexors at week 4. The outcome in ESWT group (−0.80 ± 0.41) was similar to that in BoNT-A group (−0.90 ± 0.44), with the higher confidence limit (0.33) for the difference between groups within the pre-specified margin of 0.5, indicating non-inferiority of ESWT to BoNT-A. Our results suggest that ESWT is a non-inferior treatment alternative to BoNT-A for post-stroke upper limb spasticity. Our results provide physicians with more options for the treatment of spasticity in patients with stroke.

Botulinum toxin for treatment of spasticity in patients with primary lateral sclerosis

Primary lateral sclerosis:(PLS) is a rare motoneuronal disease resulting in pyramidal and bulbar syndrome. The clinical pattern mimics amyotrophic lateral sclerosis (ALS). Nevertheless, PLS evolution resembles hereditary spastic paraplegia and most of the patients have a good life expectancy. Spasticity is a major symptom of the disease. Despite the rarity of the disease, many patients with PLS are referred to our department. This study describes spasticity management and outcome in patients with PLS using botulinum toxin injections. Between 2009 and 2015, 55 patients suffering from PLS with either paraparesis or tetraparesis were referred to the specialized consultation in physical rehabilitation medicine department in Hospital Pitié-Salpêtrière in Paris, in order to manage their spasticity. Their medical charts were retrospectively analyzed, to determine the effects of botulinum toxin therapy. Among the 55 patients, 44 patients received botulinum toxin injections, preceded by motor block for 16 patients. Injections were mostly performed in lowers limbs in order to ameliorate comfort, or ambulation. The treatment was uncomplicated. Among the 44 patients treated with botulinum toxin injections, 28 patients (63.6%) were satisfied by the treatment. Twenty-two patients (50%) underwent botulinum toxin therapy for at least a year, 6 patients (13.6%) for more than 3 years. This study confirms the interest of botulinum toxin for the treatment of spasticity in patients with PLS as it provided clinical improvement of spasticity in almost two thirds of our patients. PLS evolutes slowly, this treatment could be reiterated in a long-term approach.

Intrathecal Baclofen Therapy for the Treatment of Spasticity in Sjögren-Larsson Syndrome

Intrathecal baclofen therapy is widely accepted as a treatment option for patients with severe spasticity. The current treatment of spasticity in patients with Sjögren-Larsson syndrome is largely symptomatic, given that no effective causal therapy treatments are available. We report the outcome of 2 patients with Sjögren-Larsson syndrome who had pump implantation for intrathecal baclofen. We observed a positive response, with a decrease of spasticity, reflecting in the Modified Ashworth Scale, and parents and caregivers observed a functional improvement in both patients. One patient experienced skin irritation 15 months after surgery, necessitating pump repositioning. No infection occurred. Our report shows that intrathecal baclofen therapy can have a positive therapeutic effect on spasticity in patients with Sjögren-Larsson syndrome, and therefore may be a promising addition to current treatments.

The Safety and Efficacy of Arbaclofen Extended Release Tablets in the Treatment of Spasticity in Patients with Multiple Sclerosis

The Safety and Efficacy of Arbaclofen Extended Release Tablets in the Treatment of Spasticity in Patients with Multiple Sclerosis

A Randomized, Double-Blind, Parallel Group Study to Compare the Safety and Efficacy of Arbaclofen Extended Release Tablets to Placebo and Baclofen for the Treatment of Spasticity in Patients with Multiple Sclerosis (P3.034)

A Randomized, Double-Blind, Parallel Group Study to Compare the Safety and Efficacy of Arbaclofen Extended Release Tablets to Placebo and Baclofen for the Treatment of Spasticity in Patients with Multiple Sclerosis (P3.034)

Intrathecal Baclofen Pumps do not Accelerate Progression of Scoliosis in Quadriplegic Spastic Cerebral Plasy

IntroductionIntrathecal baclofen pumps are an effective treatment for spasticity in patients with cerebral palsy. Recently, concerns have been raised regarding the potential for intrathecal baclofe...