Spasticity and spastic dystonia: the two faces of velocity-dependent hypertonia

Marinelli, Lucio; Currà, Antonio; Trompetto, Carlo; Capello, Elisabetta; Serrati, Carlo; Fattapposta, Francesco; Pelosin, Elisa; Phadke, Chetan P.; Aymard, Claire; Puce, Luca; Molteni, Franco; Abbruzzese, Giovanni; Bandini, Fabio

doi:10.1016/j.jelekin.2017.09.005

Cited by 31 publications

(45 citation statements)

References 11 publications

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“…Moreover, eight subjects with spastic dystonia showed no pathological postures at the wrist, while in 1 subject without spastic dystonia the wrist was flexed. These observations lead us to be warned that the simple inspection of clinical posturing can be misleading in the assessment of spastic dystonia (Marinelli et al 2017). Unfortunately, due to the few subjects affected by spasticity, the sample size was too small to make valid correlations between EMG findings and the clinical picture.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in patients with pure spasticity, repeated muscle stretching is invariably followed by reflex habituation, therefore by clinical benefit. In some patients with spastic dystonia, reflex habituation is replaced by paradoxical reflex facilitation (Marinelli 2017), therefore by exacerbation of muscle hypertonia.…”

Section: Discussionmentioning

confidence: 99%

“…The angle values detected by the electronic goniometer were used to calculate onset and termination times of the dynamic phase of the stretch (phase 2). Onset and termination times were visually detected on the goniometer trace displayed on the computer screen, using a display gain of 20°/cm and a temporal window of 340ms/cm (Marinelli et al 2017).…”

Section: Analysis Of Datamentioning

confidence: 99%

“…However, in some subjects the muscle was actually relaxed prior to muscle stretch, indicating the presence of spasticity (73% of the sample). In the remaining subjects, there was an irrepressible spontaneous tonic contraction prior to muscle stretch, indicating the presence of spastic dystonia (Marinelli et al 2017).…”

Section: Introductionmentioning

confidence: 98%

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Spastic dystonia in stroke subjects: prevalence and features of the neglected phenomenon of the upper motor neuron syndrome

Trompetto

Currà

Puce

et al. 2019

Clinical Neurophysiology

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Objective: Spastic dystonia is one of the positive phenomena of the upper motor neuron syndrome (UMNS). It is characterised by the inability to relax a muscle leading to a spontaneous, although stretch-sensitive, tonic contraction. Although spastic dystonia is a recognized cause of muscle hypertonia, its prevalence among hypertonic muscles of stroke subjects has never been investigated.Differently from spasticity, which is an exaggerated stretch reflex, spastic dystonia is viewed as an efferent phenomenon, due to an abnormal central drive to motoneurons.Methods: In 23 hemiparetic stroke subjects showing increased muscle tone of wrist flexors, surface EMG was used to investigate the presence of spontaneous, stretch-sensitive EMG activity in flexor carpi radialis.Results: Spontaneous, stretch-sensitive EMG activity was found in 17 subjects. In the remaining 6 subjects, no spontaneous EMG activity was found. Conclusions:The majority of stroke subjects is affected by spastic dystonia in their hypertonic wrist flexor muscles. Only a minority of subjects is affected by spasticity.Significance: To stop spastic dystonia from being the neglected aspect of UMNS, it is essential to link its definition to increased muscle tone, as occurred for spasticity. Recognizing the real phenomena underling muscle hypertonia could improve its management. Highlights:· 74% of stroke subjects was affected by spastic dystonia in their hypertonic wrist flexor muscles · Only a minority of stroke subjects was affected by spasticity in their hypertonic wrist flexor muscles · Evaluation of EMG activity during static muscle stretch is pivotal to assess spastic dystonia

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Analysis Of Datamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Spastic dystonia in stroke subjects: prevalence and features of the neglected phenomenon of the upper motor neuron syndrome

Trompetto

Currà

Puce

et al. 2019

Clinical Neurophysiology

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“…The term "spastic dystonia" was coined by Denny-Brown in 1966 to define tonic-chronic muscle activity that is present in a spasticity pattern, during rest [15]. Thus, spastic dystonia could be described as a spontaneous overactivity at rest, not induced by a primary triggering factor [14][15][16]. It is easy to recognise it in patients with spastic paresis, as spastic dystonia causes specific bad postures in joints and body.…”

Section: Spastic Dystoniamentioning

confidence: 99%

Spasticity and Dystonia: A Brief Review

Cimino¹,

Chisari²,

Patti³

2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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Spasticity and dystonia are two neurological conditions with a broad range of clinical manifestations that can emerge at any age. Although the spasticity and dystonia symptoms are caused by different pathophysiological mechanisms, both of them may cause functional impairment that contributes to a poor quality of life. Spasticity is characterised by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex. It mostly occurs in disorders of the central nervous system (CNS) affecting the upper motor neurons, such as multiple sclerosis, amyotrophic lateral sclerosis, cerebrovascular diseases, cerebral palsy, traumatic brain injury, stroke, and spinal cord injury. Therapeutic options may combine, in various proportions, physical therapy, occupational therapy, self-rehabilitation, the use of orthoses and assistive devices, drug treatment, orthopaedic surgery, and neurosurgery. Dystonia is defined as a syndrome of involuntary movement that manifests as excessive muscle contractions that frequently cause twisting and repetitive movements or abnormal postures. It is often intensified or exacerbated by physical activity, and symptoms may progress into adjacent muscles. Dystonia has many different manifestations and causes, and many different treatment options are available. These options include physical and occupational therapy, oral medications, intramuscular injection of botulinum toxins, and neurosurgical interventions.

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A randomized, double‐blind, placebo‐controlled trial of DaxibotulinumtoxinA for Injection for the treatment of upper limb spasticity in adults after stroke or traumatic brain injury

Patel,

Munin,

Ayyoub

et al. 2024

PM&R

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BackgroundIntramuscular injection of botulinum toxin type A is a first‐line pharmacotherapy for adults with upper limb spasticity (ULS). However, reemergence of symptoms within 12 weeks of treatment is common and longer‐lasting treatments are needed.ObjectiveTo evaluate the efficacy and safety of three doses of DaxibotulinumtoxinA for Injection (DAXI) for treatment of ULS in adults with stroke or traumatic brain injury.InterventionIntramuscular injections of placebo (N = 24), DAXI 250 U (N = 22), DAXI 375 U (N = 19), or DAXI 500 U (N = 18) to the suprahypertonic muscle (SMG) and other muscle groups.DesignRandomized, double‐blind, placebo‐controlled study.SettingTwenty‐six study centers across the United States.ParticipantsEighty‐three adult patients with ULS were randomly assigned to each treatment group and followed for up to 36 weeks.Outcome MeasuresCo‐primary endpoints were the Modified Ashworth Scale (MAS) score change from baseline in the designated SMG and Physician Global Impression of Change (PGIC) at Week 6.ResultsThe mean changes from baseline in MAS score for the designated SMG for placebo and the DAXI 250 U, 375 U, and 500 U groups were −0.6, −0.9, −0.9, and −1.8, respectively, at Week 4 and −0.8, −0.9, −1.0, and −1.5, respectively, at Week 6. Statistically significant improvement in MAS score compared with placebo was reported only for the 500 U dose (Week 4: p < .001; Week 6: p = .049). Significant improvements in PGIC ratings compared with placebo were reported for DAXI 375 U (p = .015) and DAXI 500 U (p = .009) at Week 4 but not for any DAXI doses at Week 6. All DAXI doses were well tolerated with no trend toward more adverse events with increased dose.ConclusionResults from this Phase 2 study indicate that DAXI 500 U is effective and well tolerated for treatment of adults with ULS.

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Spasticity and spastic dystonia: the two faces of velocity-dependent hypertonia

Cited by 31 publications

References 11 publications

Spastic dystonia in stroke subjects: prevalence and features of the neglected phenomenon of the upper motor neuron syndrome

Spastic dystonia in stroke subjects: prevalence and features of the neglected phenomenon of the upper motor neuron syndrome

Spasticity and Dystonia: A Brief Review

A randomized, double‐blind, placebo‐controlled trial of DaxibotulinumtoxinA for Injection for the treatment of upper limb spasticity in adults after stroke or traumatic brain injury

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