EpistemisMuscle spasticity predominantly in the lower extremities
Specialty: Pediatrics.
Why it occurs
- Infantile cerebral palsy type spastic diplegia (non-progressive perinatal motor brain damage, frequently secondary to periventricular leukomalacia in premature newborns)
- Familial or hereditary spastic paraparesis (genetically based neurodegenerative disorder that causes progressive retrograde degeneration of the axons of the pyramidal tract)
- Spinal cord malformations or syringomyelia (compression or alteration of upper motor neuron transmission in the spinal cord)
- Brain trauma or sequelae of severe meningitis/encephalitis (acquired lesion of the motor cortex or pyramidal tracts)
Initial workup
Detailed neurological examination that includes assessment of muscle tone using the modified Ashworth scale, deep tendon reflexes (patellar, Achilles), pathological reflexes (Babinski, clonus) and gait analysis (scissors or tiptoe walking). Magnetic Resonance (MRI) of the brain and complete spinal cord (the study of choice to characterize structural lesions such as periventricular leukomalacia, spinal malformations or demyelination). Molecular genetic study (sequencing or targeted panels for familial spastic paraparesis if brain MRI is normal).
red flags
Acute and progressive loss or deterioration of walking or the ability to remain standing; marked asymmetry of spasticity (exclusive or much greater involvement of one extremity compared to the other); presence of inexhaustible clonus upon rapid stretching of the Achilles tendon; loss of sphincter control (new onset fecal or urinary incontinence); difficulty swallowing, dysarthria or signs of associated bulbar cranial nerve involvement.
Standard management
- Medical treatment of spasticity is symptomatic and multidisciplinary — physiotherapy, orthoses). Baclofen (GABA-b receptor agonist that reduces the transmission of monosynaptic and polysynaptic reflexes in the spinal cord; initial dose of 5 mg/day orally divided into 3 doses, gradually increasing to a maximum of 30-40 mg/day in children; in severe refractory cases, intrathecal baclofen can be used using an implantable pump.
- Botulinum toxin type A — injected locally under ultrasound control into selective target muscles such as the gastrocnemius or adductors to produce temporary chemical denervation; dose calculated in units per kg of body weight, repeatable every 4-6 months
- Diazepam (used for its muscle-relaxing effect mainly at night; dose of 0.1 to 0.3 mg/kg/day).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Pediatrics
- Listed causes
- 4
- Treatment options
- 3