Which interventions are useful for managing muscle spasticity in individuals who sustained traumatic brain injury? – A Cochrane Review summary with commentary

Laxe, Sara

doi:10.3233/nre-189003

Cited by 9 publications

(5 citation statements)

References 3 publications

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“…Focal injections were also widely used. The extensive use of injections and physical modalities allowed our institution to minimize the use of systemic spasmolytic medications, which can adversely affect arousal and cognition 12 . The injections administered consisted of both phenol and BoNT.…”

Section: Discussionmentioning

confidence: 99%

“…The extensive use of injections and physical modalities allowed our institution to minimize the use of systemic spasmolytic medications, which can adversely affect arousal and cognition. 12 The injections administered consisted of both phenol and BoNT. Phenol neurolysis can effectively manage spasticity in several muscles innervated by the same nerve, which is helpful in managing the widespread severe spasticity in persons with DoC.…”

Section: Spasticity Management In Docmentioning

confidence: 99%

“…Current spasticity treatment options include physical modalities, 7,8 focal injections (chemodenervation with botulinum neurotoxin [BoNT] or phenol neurolysis), [9][10][11] systemic medications (mainly baclofen, tizanidine, dantrolene), 12 and invasive surgical approaches (intrathecal baclofen [ITB], selective dorsal rhizotomy [SDR], and thalamic stimulation). 5,6,13 Of these, only bracing, BoNT, and systemic and intrathecal baclofen have been reported for spasticity management in this population.…”

Section: Introductionmentioning

confidence: 99%

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Spasticity Management in Persons with Disorders of Consciousness

Zhang

Karri

O’Brien

et al. 2020

PM&R

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Introduction Spasticity is one of the most frequent neurological impairments affecting persons with disorders of consciousness (DoC). If left untreated, it can mask signs of consciousness by inhibiting one's ability to interact with the environment. The lack of information about spasticity specific to patients with DoC may result in insufficient or even inappropriate treatment. Objective To report spasticity characteristics and management in a large dedicated DoC rehabilitation program. Design Retrospective chart review. Setting An inpatient rehabilitation hospital. Participants Patients admitted to the DoC rehabilitation program from 1 January 2014 to 31 October 2018. Main Outcome Measurements Spasticity characteristics; impact of interventions on spasticity as well as other clinical measures. Results A total of 146 patients were included, of whom 95.2% were affected by spasticity; 52.7% had spasticity affecting all four limbs. The most commonly affected muscle groups were shoulder internal rotators (72.6%) in the upper extremity and ankle plantar flexors (59.8%) in the lower extremity. The more commonly affected muscle groups were also more spastic (R = 0.993 and 0.989 in the upper and lower extremity, respectively; P < .01). Atypical posture patterns were also commonly observed, making positioning difficult. Chemoneurolytic injections (botulinum toxin and/or phenol) were performed in over 69.9% patients, and 26.7% had intrathecal baclofen (ITB) pump placement. All patients received individualized physical modalities and therapies. With focal managements, systemic spasmolytic medications, including enteral baclofen, were reduced by at least 50.0%, which appeared to be associated with improvements in the level of consciousness. Conclusions Almost all DoC patients were affected by spasticity, often to a moderate or severe degree. Extensive use of focal spasticity interventions allowed for weaning of systemic spasmolytic medications, which seemed to result in improvements in the level of consciousness.

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Section: Discussionmentioning

confidence: 99%

Section: Spasticity Management In Docmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spasticity Management in Persons with Disorders of Consciousness

Zhang

Karri

O’Brien

et al. 2020

PM&R

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“…Одним из выводов обзора явилось то, что эффективнее плацебо ботулотоксин снижает спастичность через 4 нед. и баклофентонус через 6 ч [36]. В метаанализе J.E.…”

Section: реабилитация пациентов со спастическим парезомunclassified

Current trends in the rehabilitation of patients with spastic paresis with focal brain damage

2021

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Spasticity is one of the most frequent movement disorders and its development is associated with such CNS lesions as stroke, multiple sclerosis, cerebral palsy, craniocerebral and spinal injuries, CNS tumors, neurodegenerative diseases. Post-stroke spasticity develops in about 40% of patients, and about 15% of patients have severe and disabling spasticity. According to statistics, after TBI, about 75% of patients develop spasticity, and half of them require treatment.Spasticity worsens walking, complicates hygiene, dressing, complicates rehabilitation measures, and reduces the quality of life of patients and his family members. In recent years, this movement disorder has been actively studied, new data have appeared on the pathophysiology of spastic paresis and encouraging data on improving function in patients receiving botulinum toxin injections as part of multidisciplinary rehabilitation.The article presents data from the latest systematic reviews on the effectiveness of various rehabilitation technologies for the treatment of spasticity.The use of botulinum neurotoxin for the treatment of spastic paresis of the upper and lower extremities is the preferred method of complex multidisciplinary rehabilitation of patients with spasticity and has the highest level of evidence.Currently, there is no doubt that botulinum toxin should be used as early as possible in patients with an emerging pathological movement pattern, which can contribute to pattern change and muscle length maintenance. But the question remains: which rehabilitation technology is most effective for enhancing and prolonging the action of botulinum neurotoxin. To date, there is no clear answer to this question.

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“…É indispensável associar medidas nãofarmacológicas, como fisioterapia motora, terapia ocupacional e uso de órteses. 3 A escolha da modalidade do tratamento depende das características da espasticidade, especialmente se é generalizada, focal ou multifocal. Na espasticidade generalizada, o uso de medicamentos com efeito de relaxamento muscular é frequente; enquanto na espasticidade focal ou multifocal, os bloqueios neurolíticos, com fenol, álcool ou toxina botulínica, constituem a principal opção de tratamento.…”

Section: Introductionunclassified

O fenol como agente neurolítico no tratamento da espasticidade focal e multifocal

et al. 2019

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A síndrome piramidal ocorre nas lesões do sistema nervoso central que afetam as vias corticoespinhais e são definidas pela tríade de fraqueza muscular, aumento dos reflexos miotáticos e espasticidade, que é definida pelo aumento involuntário da resistência ao movimento passivo cuja intensidade varia com a velocidade do movimento. Quando a espasticidade interfere na funcionalidade do paciente, dificultando o movimento ativo, causando dor ou dificultando a prestação de cuidados por terceiros, há necessidade de iniciar seu tratamento. Para o tratamento da espasticidade generalizada ou de grandes porções do corpo, a intervenção medicamentosa ocorre por via oral ou intratecal, conforme os recursos disponíveis, mas efeitos colaterais de intensidade variável e indesejáveis podem ocorrer, especialmente o comprometimento da atenção ou da consciência, que prejudicam o processo de reabilitação. O tratamento focal da espasticidade utiliza a toxina botulínica ou os bloqueios nervosos com fenol ou álcool. Este artigo revisa a literatura sobre as técnicas mais adequadas para realizar a neurólise com fenol. Os bloqueios neuromusculares com fenol são um tratamento efetivo, de ação imediata, baixo custo, duração prolongada e de poucos efeitos adversos quando são respeitados os cuidados regulares de aplicação.

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Which interventions are useful for managing muscle spasticity in individuals who sustained traumatic brain injury? – A Cochrane Review summary with commentary

Cited by 9 publications

References 3 publications

Spasticity Management in Persons with Disorders of Consciousness

Spasticity Management in Persons with Disorders of Consciousness

Current trends in the rehabilitation of patients with spastic paresis with focal brain damage

O fenol como agente neurolítico no tratamento da espasticidade focal e multifocal

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