Spasticity Management - Hoessini

Why do we WANT to treat spasticity? (3)

1. Improve function

2. Improve quality of life

3. Prevent secondary problems

Why should we NOT treat spasticity? (2)

1. It is not causing a problem

2. It is actually helpful - Can substitute for significant weakness

True or False: Spasticity can be cured

FALSE: Spasticity cannot be cured but it can usually be managed

What are non-pharmacological ways to treat spasticity? (4)

- Very slow stretching

- Daily movement

- E-stim of antagonistic muscles

- Splints

Oral medications can be used for _________ spasticity or spasms affecting multiple parts of the body.

Diffuse

What is the main side effect from taking oral medications for spasticity?

Drowsiness

GABA b receptor agonist - inhibits reflexes at the spinal cord and brain level

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

Baclofen

Side Effects include:

- Drowsiness/Cognitive Slowing

- Weakness

- Dizziness

- Nausea

- Dry Mouth

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

Baclofen

Centrally acting Alpha 2 adrenergic agonist - Presynaptic inhibition of motor neurons in brain and spinal cord

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

Tizanidine

Side Effects include:

- Drowsiness

- Dizziness

- Hypotension

- Dry Mouth

- Fatigue

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

Tizanidine

- Suppresses GABA mediated spinal reflexes

- Better on flexor than extensor spasms

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

Diazepam

Side Effects include:

- Drowsiness

- Weakness

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

Diazepam

- Works at muscle level

- Blocks release of calcium within skeletal muscle, thus decreasing contraction

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

E. Dantrolene

Dantrolene

Side Effects Include:

- Hepatitis (monitor liver enzymes)

- Weakness

- Lightheadedness

- Nausea

- Diarrhea

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

E. Dantrolene

Dantrolene

- Local muscle injections

- Often good choice for focal spasticity

- Most often use EMG guidance

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

E. Dantrolene

Botulinum Toxin

- Sometimes use ultrasound or motor point stimulation

- Avoids drowsiness

- Therapeutically weakens muscles to meet treatment goals

A. Baclofen

B. Diazepam

C. Tizanidine

D. Botulinum Toxin

E. Dantrolene

Botulinum Toxin

Maximum response of botulinum toxin is seen at ____ to _____ weeks.

4 to 8 weeks

Botulinum toxin injections are typically every ____ to ____ months.

3 to 4 months

Onset of botulinum toxin is usually seen within the first ____ days after injection.

3

It is key to perform a ____________ within the therapeutic window of botulinum toxin.

Reassessment

During the therapeutic window of botulinum toxin injection - Good communication between _________ and ________ is key to success.

Therapist and Physiatrist

- Performed with nerve stimulation and ultrasound guidance

- Semi permanent treatment with phenol

- Causes numbness along with weakness of targeted areas

- Temporary dysesthesia

A. Intrathecal Baclofen Pump

B. Nerve Block

Nerve Block

- When oral baclofen not tolerated

- Trial first to determine efficacy

- Catheter delivers medicine into cerebral spinal fluid

- Requires surgery to insert

A. Intrathecal Baclofen Pump

B. Nerve Block

Intrathecal Baclofen Pump

How long does a nerve block typically last?

Several hours

How long does a nerve block typically last if used with phenol?

Several months

Nerve blocks can help differentiate if it is severe _________ vs _________.

Spasticity vs contracture

If nerve block is used with phenol - what muscle groups are frequently targeted? (3)

- Hip adductor

- Plantar flexors

- Elbow flexion

What do we want to avoid in a nerve motor point block? (2)

- Numbness

- Dysesthesia

What is an intrathecal baclofen pump indicated for?

Severe spasticity in the trunk and legs

An intrathecal baclofen pump needs to be replaced every ____ years.

7 years