Spasticity.
Treatment of spasticity requires a team approach, including the patient and caregivers, therapists, physicians, and surgeons. The team needs to determine what component of the spasticity interferes with function. Traditional therapy continues to dominate the therapy provided to patients who are living with spasticity. Treatment of increased tone must be part of the overall treatment plan for the patient. The plan may also include physical and occupational therapy, oral medication, injections of botulinum toxin, use of an intrathecal baclofen pump, or surgery. For patients with limited improvement from therapy, injections of botulinum toxin are often first-line treatment for focal spasticity involving overactive muscle groups. Botulinum toxin is safe when used at recommended doses and has limited side effects. The benefits of oral medications in patients with focal spasticity may be limited by adverse effects at higher doses. Refractory spasticity may be treated with intrathecal baclofen. Surgery is reserved for patients in whom the other modalities fail to provide meaningful improvement. Continued communication from all members of the team can assure the best spasticity management plan for the individual patient, but patients need to have realistic expectations about outcome.
Allison Brashear, MD Wake Forest University Health Sciences, Department of Neurology, Medical Center Boulevard, Winston-Salem, NC 27157, USA. abrashea@wfubmc.edu.
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