Spasticity following brain and spinal cord injury: assessment and treatment

Abstract

Purpose of reviewSpasticity is a common sequela of brain and spinal cord injury and contributes to disability, reduces quality of life, and increases economic burden. Spasticity is still incompletely recognized and undertreated. We will provide an overview of recent published data on the definition, assessment, and prediction, therapeutic advances, with a focus on promising new approaches, and telemedicine applications for spasticity.Recent findingsTwo new definitions of spasticity have been recently proposed, but operational criteria should be developed, and test–retest and inter-rater reliability should be explored. Cannabinoids proved to be effective in spasticity in multiple sclerosis, but evidence in other types of spasticity is lacking. Botulinum neurotoxin injection is the first-line therapy for focal spasticity, and recent literature focused on optimizing its efficacy. Several pharmacological, interventional, and nonpharmacological therapeutic approaches for spasticity have been explored but low-quality evidence impedes solid conclusions on their efficacy. The recent COVID-19 pandemic yielded guidelines/recommendations for the use of telemedicine in spasticity.SummaryDespite the frequency of spasticity, robust diagnostic criteria and reliable assessment scales are required. High-quality studies are needed to support the efficacy of current treatments for spasticity. Future studies should explore telemedicine tools for spasticity assessment and treatment.

Role of Diagnostic Nerve Blocks in the Goal-Oriented Treatment of Spasticity with Botulinum Toxin Type A: A Case–Control Study

“…The new findings of our study are that DNBs may further optimize the goal-setting process for BoNT-A treatment of patients with disabling spasticity towards more realistic and achievable goals. Future studies should explore the role of DNBs in these patients’ treatments, whether its therapeutic yield to BoNT-A injection is comparable across different disease stages, and if it may help in understanding if other treatments (e.g., intrathecal baclofen, phenol neurolysis, and spasticity-reducing surgery) [ 22 ] may be more appropriate, alone or in combination with BoNT-A, to achieve a specific goal. Multicenter randomized controlled trials may help answer these questions.…”

Glycine and N-Acetylcysteine (GlyNAC) Combined with Body Weight Support Treadmill Training Improved Spinal Cord and Skeletal Muscle Structure and Function in Rats with Spinal Cord Injury

“…SCI predisposes patients to upper motor neuron damage which triggers spinal motor neuron excitation and leads to spasticity and elevated muscle tone which are prevalent in patients with cervical, thoracic, and lumbar medullary injuries [41][42][43][44], which severely affects their functional recovery and reduces their quality of life [45]. An increase in tension is common in patients with cervical and lumbar cord injuries [38], while elevated skeletal muscle tone after SCI has been shown to have beneficial effects by preserving skeletal muscle properties and attenuating the slow-to-fast conversion of myosin [46,47].…”

Chronic pain among Lebanese individuals with spinal cord injury: Pain interference and impact on quality of life

“…Spinal cord injury (SCI) is a serious medical condition that leads to a significant disability. 1 Various health complications result from SCI including sensory and motor function impairments, neurogenic bladder and bowel function problems, 2 , 3 cardiovascular and respiratory complications, 4 sexual disorders, 5 spasticity, 6 chronic pain, 7 and others. 8 These underlying problems affect the patient's physical and psychological functioning, which significantly impacts their quality of life (QOL).…”