EpistemisSpasticity
Specialty: Neurology.
Why it occurs
- Crebrovascular accident (sequela of upper motor neuron injury)
- Multiple sclerosis and other demyelinating diseases of the central nervous system
- Severe head trauma or traumatic spinal cord injury
- Childhood cerebral palsy (non-progressive encephalopathy)
- Cervical spondylotic myelopathy (chronic spinal cord compression)
Initial workup
Clinical evaluation using the modified Ashworth Scale to quantify the degree of spasticity; magnetic resonance imaging (MRI) of the brain or spinal cord (cervical/dorsal) depending on the level of suspicion of pyramidal tract injury; electromyography and nerve conduction studies to assess the integrity of the motor pathway.
red flags
Sudden and severe increase in spastic muscle tone associated with fever (risk of hyperthermia or underlying infection), acute urinary retention, painful pressure ulcers or autonomic dysreflexia in patients with spinal cord injuries above T6 (medical emergency characterized by severe paroxysmal hypertension).
Standard management
- Baclofen — 10-80 mg/day orally, or by intrathecal infusion pump in severe refractory cases
- Tizanidine — 2-24 mg/day, central alpha-2 adrenergic agonist
- Dantrolene — 25-400 mg/day, acts directly on the excitation-contraction coupling of skeletal muscle
- Botulinum toxin type A (directed intramuscular infiltration in focal spastic muscle groups).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 4