Spasticity Management in Disorders of Consciousness

Abstract

Background: Spasticity is a motor disorder frequently encountered after a lesion involving the central nervous system. It is hypothesized to arise from an anarchic reorganization of the pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected muscular groups. While this symptom and its management is well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management in patients presenting disorders of consciousness after brain damage. Objectives: Our aim was to review the occurrence of spasticity in patients with disorders of consciousness and the therapeutic interventions used to treat it. Methods: We conducted a systematic review using the PubMed online database. It returned 157 articles. After applying our inclusion criteria (i.e., studies about patients in coma, unresponsive wakefulness syndrome or minimally conscious state, with spasticity objectively reported as a primary or secondary outcome), 18 studies were fully reviewed. Results: The prevalence of spasticity in patients with disorders of consciousness ranged from 59% to 89%. Current treatment options include intrathecal baclofen and soft splints. Several treatment options still need further investigation; including acupuncture, botulin toxin or cortical activation by thalamic stimulation. Conclusion: The small number of articles available in the current literature highlights that spasticity is poorly studied in patients with disorders of consciousness although it is one of the most common motor disorders. While treatments such as intrathecal baclofen and soft splints seem effective, large randomized controlled trials have to be done and new therapeutic options should be explored.

Changes of Spasticity across Time in Prolonged Disorders of Consciousness: A Retrospective Study

“…As per our statistical analyses, this difference was not related to other factors such as age, time since injury, the presence of spastic medication, or the level of consciousness at the first time-point. Spasticity is related to lesions of the upper motor neurons, which project out cortically from the primary motor cortex to the brainstem before descending down the spinal cord [ 2 ]. Traumatic brain injury is often related to localized lesions that do not systematically involve primary lesions in the motor cortex.…”

“…Spasticity frequently develops in patients with severe brain injury who are diagnosed with a prolonged disorder of consciousness (DOC). More exactly, the prevalence of spasticity in DOC patients ranged from 59% to 89% in a recent review of 18 published articles [ 2 ]. This prevalence is especially concerning since spasticity impacts the patients’ rehabilitation process and quality of life.…”

Levetiracetam Improves Upper Limb Spasticity in a Patient With Unresponsive Wakefulness Syndrome: A Case Report

“…Up to 89% of patients with DOC suffer from spasticity characterized by atypical clinical patterns related to widespread lesions at various levels of the central nervous system and poorly controlled by the standard pharmacological treatments (Thibaut et al, 2015b;Martens et al, 2017). While this syndrome and its management are well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, there are no guidelines regarding its appropriate management in DOC patients (Martens et al, 2017). In this population, spasticity has particularly negative impacts (e.g., muscle contractures, loss of range of movement, bedsores) and is strongly correlated with pain (Thibaut et al, 2015b).…”

“…While this syndrome and its management are well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, there are no guidelines regarding its appropriate management in DOC patients (Martens et al, 2017). In this population, spasticity has particularly negative impacts (e.g., muscle contractures, loss of range of movement, bedsores) and is strongly correlated with pain (Thibaut et al, 2015b). In addition, spasticity involves long-term complications and difficulties in nursing activities that consistently reduce patients' quality of life and possibility of functional recovery.…”

Inter-and intra-rater analysis of hemiparetic shoulder abduction using PhysioPlay™

“…Such changes imply significant immobility, limitations in upper limb function, and delays in the rehabilitation of these patients. 3 An important subsystem of the somatosensory system involves proprioception, which, when altered, impairs the feedback and control of the advancement of therapies, negatively influencing joint range of motion (ROM), stability movements, and coordination. 1 The most commonly used instrument for measuring ROM is the universal goniometer.…”