Management of Spasticity After Traumatic Brain Injury in Children

Abstract

Traumatic brain injury is a common cause of disability worldwide. In fact, trauma is the second most common cause of death and disability, still today. Traumatic brain injury affects nearly 475 000 children in the United States alone. Globally it is estimated that nearly 2 million people are affected by traumatic brain injuries every year. The mechanism of injury differs between countries in the developing world, where low velocity injuries and interpersonal violence dominates, and high-income countries where high velocity injuries are more common. Traumatic brain injury is not only associated with acute problems, but patients can suffer from longstanding consequences such as seizures, spasticity, cognitive and social issues, often long after the acute injury has resolved. Spasticity is common after traumatic brain injury in children and up to 38% of patients may develop spasticity in the first 12 months after cerebral injury from stroke or trauma. Management of spasticity in children after traumatic brain injury is often overlooked as there are more pressing issues to attend to in the early phase after injury. By the time the spasticity becomes a priority, often it is too late to make meaningful improvements without reverting to major corrective surgical techniques. There is also very little written on the topic of spasticity management after traumatic brain injury, especially in children. Most of the information we have is derived from stroke research. The focus of management strategies are largely medication use, physical therapy, and other physical rehabilitative strategies, with surgical management techniques used for long-term refractory cases only. With this manuscript, the authors aim to review our current understanding of the pathophysiology and management options, as well as prevention, of spasticity after traumatic brain injury in children.

Ultrasound Elastography in the Assessment of the Stiffness of Spastic Muscles: A Systematic Review

“…It is defined as a "disordered sensory-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles" (Pandyan et al 2005). Spasticity is a medical problem with a high incidence of approximately 30% that affects both children and adults with neurodegenerative diseases, namely cerebral palsy, cranioencephalic trauma, stroke or spinal cord injury (Enslin et al 2020). It can lead to childhood development disorders, reduced functional capacit, and abnormal postures that eventually cause pain.…”

Single Residue Variation in Skeletal Muscle Myosin Enables Direct and Selective Drug Targeting for Spasticity and Muscle Stiffness

“…Spasticity develops as a consequence of complex rearrangements of supraspinal inputs, which transforms the synaptic regu-lation of motoneurons that drives muscle contraction. The resulting exaggerated stretch reflex is accompanied with disrupted balance in regulation from the premotor cortex and reticular formation of the brainstem, which finally leads to aberrantly increased potentiation of motoneurons and hypercontraction of muscles (Enslin et al, 2020;Mukherjee and Chakravarty, 2010;Trompetto et al, 2014).…”

Emerging Treatments for Disorders of Consciousness in Paediatric Age

“…In particular, spasticity and dystonia can hamper timely and appropriate delivery of rehabilitation and induce pain, and thus need to be treated. General guidelines exist, which are not specific to children, although they partially target paediatric needs [ 26 , 27 ]. On the other hand, medications for spasticity can induce fatigue as a side effect, thus resulting in a disadvantageous factor to the overall regaining of consciousness and dragging patients into a vicious circle.…”