- The first step in the treatment of spasticity is to identify the aims and realistic goals of therapy.
- To reduce the impact of spasticity
- To prevent secondary complications
- Relief of discomfort
- Improved sitting, standing and walking, facilitated activities of daily living
- Rreduced burden of care
- Iimproved body image and self-esteem
- Prevention of complications
- A) Pharmacological
The oral agents:
Most commonly used drugs to treat spasticity are:-
Baclofen (Lioresal)- is an analog of gamma amino-butyric acid (GABAB ), a neurotransmitter involved in presynaptic inhibition.
Tizanidine- is α-2 receptor agonist. It inhibits excitatory spinal interneurons and tracts from locus coeruleus.
Dantrolene sodium (Dantrium – is the only drug which acts at a muscular (rather than a segmental reflex) level. It reduces muscle action potential induced by calcium release into the sarcoplasmic reticulum.
Diazepam (Valium )- has no direct GABA-mimetic effects, but exerts indirect effects only if GABA transmission is functional.
Botulinum toxin– Inhibits release of acetylcholine, thereby blocking neuromuscular transmission. It is the most widely used treatment for focal spasticity along with physiotherapy.
The other agents available are:
Chlorpromazine with Phenytoin
Nerve and motor point blocks offer a reduction in spastic tone on a temporary basis.
Injected directly into peripheral nerves cause; destruction of neural tissue by protein coagulation.
45% of pure Alcohol Acts as a local anesthetic by decreasing sodium and potassium conductance at the nerve membrane at low concentrations. It causes protein denaturation at higher concentration.