Stroke and Spasticity Treatments
By David Wasielewski
Many individuals who survive a stroke with neuromuscular deficits eventually experience some type of spasticity. Spasticityanswers.com defines spasticity as a neuromuscular condition in which muscles contract and spasm, causing stiffness and pain.
Spasticity is the result of a disorder or damage involving the central nervous system—brain and spinal cord. The exact cause of the condition has yet to be determined so consequently researchers are having difficulty finding a cure.
Some research suggests that the loss of control over the muscle from primary motor cortex in the brain results in hyperactivity in the neuromuscular connection, the junction between the nerve and the muscle it controls. The motor neuron that controls contraction of the muscle begins to secrete constant high levels of neurotransmitter causing the muscle to go into a state of constant uncontrolled contraction.
Those suffering from this condition are often seen to carry their hands in a fist with their arms held high against their chest. The condition also results in foot drop where the ankle and toes are seen to bend inward causing inability to balance and develop a proper walking gait.
The condition often develops over time and may not fully manifest itself until several weeks or months following the stroke. In my case it was the condition was not identified until almost 10 weeks after the stroke. When I initially was treated for left side hemiplegia (paralysis) my arm and leg were totally flaccid with no muscle tone at all.
Over time the spasticity caused my hand to curl into a fist and my foot to bend inward. My therapist initially advised that an AFO for my left leg would help to straighten my leg and allow me to balance as I attempted to walk. This plastic brace was able to hold my leg in a more natural position but did not relieve the constant muscle contraction. I began to explore other treatment options.
In consultations with my neurologist and my own research I became aware of a number of treatments that are available for this condition. The first is physical and occupational therapy in order to regain some type of controlled movement in the joint. When voluntary movement is not possible a number of other options exist.
They include Oral Medication, Injected Medication, Intrathecal Medication and Surgical Treatments. Exercise is also important.
Oral medications block the actions of the neurotransmitters in the body in an attempt to lessen their effect on the muscles. They are commonly known as muscle relaxers. They have proven to be effective for many patients. The major drawback is that these medications cannot target specific muscles but effectively relax all the muscles in the body regardless if they were affected by the stroke.
The effect is that they produce muscle weakness in the entire body and often cause significant fatigue for the patient. Tinzanadine (Zanaflex) is a common oral medication. The patient generally goes through an introductory period where he/she tries various doses to get the best balance between relief of spasticity and the fatigue that the drug causes. In some cases Zanaflex can be paired with Provigil (an alertness agent) to help combat the fatigue.
Injected medications are administered directly into the effected muscle to alleviate the spasticity. Botox is the most commonly used injectable. It is more effective than the oral meds and it is muscle specific. The drawbacks are that it must be administered by a doctor, it is expensive and the effects wear off over time, usually several months. Repeated treatments are required.
Intrathecal Medications are administered directly to the central nervous system through the spinal fluid via a pump that is implanted in the abdomen. The pump administers a constant dose of the medication. While effective, the drawbacks are that it requires surgical implantation of the pump and the risks associated with that surgery.
Like the orally administered drugs it cannot target specific muscles but produces a general muscle relaxation and fatigue through the entire body.
Surgical Treatments are the most radical of the treatment options. This involves surgical modification of the joint or tendons that attachs the spastic muscle to that joint. This is normally reserved for only the most severe cases of spasticity. In some cases the tendons are lengthened or cut to reduce muscle tension and loosen the joint. Some new experimental surgeries attempt reroute the tendon through the bones in the joint to reduce tension.
Since we all know that each patient and each stroke is different, it is important to find a neurologist or physiatrist experienced in rehab medicine to prescribe an appropriate plan of treatment for this condition.
In all spasticity cases it is vitally important to regularly stretch the muscles and move the joint in order to prevent the formation of plaques within the joint. Plaque buildup in the joint will eventually freeze the joint in one position, a condition that is difficult or impossible to treat.
Exercise. Joint exercise, either through voluntary muscle movement or external manipulation by the patient or caregiver will help prevent pain and eventual freezing of the joint which has plagued so many stroke survivors in years past. If you are currently in therapy ask your therapist for exercises. A web search will also give you some instruction.
References: Medtronic's on spasticity provides general recommendation for stroke patient with this condition.
A GOOGLE query of ‘spasticity and stroke’ provides the user with hundreds of articles regarding current treatment options for the condition along with advertisements for popular drugs.
Copyright © February 2011
The Stroke Network, Inc.
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