WCNR 2018: Why do outcomes of post-stroke spasticity management vary?

At WCNR 2018, Dr Gerard Francisco Professor and chair of PM&R, UTHEALTH Neuro recovery Research Centre, TIRR Memorial Hermann, briefed about why do outcomes of post-stroke spasticity management vary?

WCNR 2018: Why do outcomes of post-stroke spasticity management vary?

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?

  • Similarities
  • Assessment
  • Clinical criteria for decision making
  • Toxin
  • Injection technique
  • Therapy Program

Differences:

  • Age
  • Sex
  • 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:

Intrinsic tonic

Exaggerated tonic stretch reflex

Neuronal changes

Changes in muscle properties

Intrinsic Phasic 

  • Reduced pre- synaptic la inhibition – hyperreflexia
  • Recurrent activation of stretch reflex

Extrinsic

  • 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
  • Surgery
  • Intrathecal therapies
  • Phenol and alcohol injections
  • Others

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.”