A Review of Spasticity Treatments: Pharmacological and Interventional Approaches.
Spasticity is a velocity-dependent increase in muscle tone and uncontrolled, repetitive, involuntary contractions of skeletal muscles. Spasticity presents as upper motor neuron symptoms in patients with central nervous system pathology such as stroke, spinal cord injury, brain injury, or multiple sclerosis. As a result, a patient can have significant pain and limited mobility, which can lead to decreased quality of life and difficulty maintaining personal care. In this article we discuss mechanisms, indications, efficacy, and side effects of the most accepted current treatments. Currently available treatment options include oral medications and interventional procedures. Oral medications comprise centrally acting agents, such as baclofen, clonidine, and tizanidine, as well as anticonvulsants such as benzodiazepines and gabapentin and peripherally acting dantrolene. Interventional procedures include focal injections of botulinum toxin, phenol or alcohol, and an intrathecal baclofen pump. Surgical treatments include selective dorsal rhizotomy and neurectomy. We found that there are several treatments available with data to support their use, but many still need further research to prove their efficacy and develop optimal utilization.
Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California.
Eric
E
Chang
School of Medicine, University of California, Irvine, Orange, California.
Nilasha
N
Ghosh
Department of Neurological Surgery, University of California, Irvine, Orange, California.
Daniel
D
Yanni
Department of Physical Medicine and Rehabilitation, University of California, Irvine, Orange, California.
Sujin
S
Lee
Department of Neurological Surgery, University of California, Irvine, Orange, California.
Daniela
D
Alexandru
Department of Neurology, MDA-ALS and Neuromuscular Center, University of California, Irvine, Orange, California.
Tahseen
T
Mozaffar
spasticity; treatment; upper motor neuron disease