On the third day of WCNR 2018, an interesting spasticity symposium (co-organised by the Spasticity SIG) was conducted.
As per Dr Gerard Francisco, Professor and chair of PM&R, UTHEALTH Neuro recovery Research Center, TIRR Memorial Hermann:
Why did treatment outcomes vary?
- Clinical criteria for decision making
- Injection technique
- Therapy Program
- Chronicity of Stroke
- Location of stroke
- (No stroke volumetric information)
- Genetic make-up?
“Injuries to the insula, the thalamus, the basal ganglia, and white matter tracts ( internal capsule, corona radiata, external capsule, and superior longitudinal fasciculus) were significantly associated with severe upper limb post-stroke spasticity, said Dr Gerard Francisco.
Types of spasticity:
Exaggerated tonic stretch reflex
Changes in muscle properties
- Reduced pre- synaptic la inhibition – hyperreflexia
- Recurrent activation of stretch reflex
- Lack of inhibition of afferent peripheral input ( “flexor reflex afferents”) that mediate polysynaptic reflexes
Spasticity treatment options:
- Botulinum toxins
- Physical modalities and therapies
- Oral drugs
- Intrathecal therapies
- Phenol and alcohol injections
According to Dr Gerard Francisco, “No two spastic presentations and conditions are alike, so perhaps the underlying pathology may vary.”
On the question, why do outcomes of post-stroke spasticity management vary? He said, “Different underlying pathologies and mechanisms should inform treatment decisions.”