Spasticity Management (Botulinum)

Spasticity is defined as a motor disorder with failure to inhibit stretch reflexes leading to increased muscle resistance. It can affect patients with congenital and acquired brain and spinal cord injuries of variable causes (traumatic, vascular or tumours). The exact prevalence of spasticity is unknown. A consensus of experts in Britain believes it to be about 20% of stroke patients and 75% of patients with severe brain injury. Spasticity varies in severity from muscle stiffness to severe, painful and uncontrollable muscle spasms. Spasticity can be general, involving multiple limbs and trunk muscles, regional, affecting a group of muscles in one or more limbs, or focal, affecting a single muscle. Spasticity can affect the ability to feed and dress oneself, bladder and bowel control, hygiene and mobility. It also predisposes to complications such as pressure sore formation due to poor seating / laying posture and contracture.

General principles of spasticity management

Spasticity management is an interdisciplinary team approach that requires thorough assessment of the individual to exclude factors that would trigger spasticity, for example; infection, painful sensory stimulation, poor posture and constipation. Formulating a management plan aims to address those factors that would contribute to and are influenced by the increased muscle tone. The medical treatment of spasticity should be tailored to the individual as part of the interdisciplinary plan of management, with clearly identified goals. The choice of treatment would depend on the set goals and on the distribution of the involved muscles.

It can range from the following:

• Systemic oral muscle relaxants work directly on the central nervous system or the muscles for generalised spasticity(e.g. Baclofen, Tizanidine, Dantrolene)
• Using a pump to introduce specific medicines into the spinal cord (Intrathecal administration of muscle relaxants via an electronic or pneumatic pump e.g. Baclofen, clonidine or morphine).
• Using Botulinum toxins: Botulinum toxin is used to treat a number of disorders characterized by overactive muscle movement, including post-stroke spasticity, post-spinal cord injury spasticity, spasms of the head and neck, limbs, jaw, and vocal cords. Similarly, botulinum toxin is used to relax clenching of muscles.
• Phenol injections. This method is used for selected individuals with progressive or stable neurology in whom spasticity involves large muscle groups affecting the lower limbs.

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Adapted from (Dr Gaid. Phenol Nerve Block for Management of Lower Limb Spasticity. ACNR). For more information and to read the full article: CLICK HERE