The spastic hip
Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode in Paediatric Orthopaedics, 2016
Common problems of the hip in cerebral palsy include adduction deformity, flexion deformity, internal rotation gait and hip subluxation and dislocation. A spastic adduction deformity of the hip may be dynamic due to spasticity of the muscles that adduct the hip or there may be a true contracture of these muscles. The adductor muscles are erased from their origin on the pubic bone and transferred more posteriorly onto the ischium. The rationale of the operation is to abolish the adductor action and enhance the hip extensor power. The first and foremost issue is to differentiate between spasticity and contracture of the adductor muscles. If a contracture is present, surgery is indicated, whereas the initial treatment of spastic adductors is essentially non-operative. If release of the hip flexion contracture is part of the procedure to reduce a spastic hip dislocation, the options for dealing with the iliopsoas tendon include tenotomy and transfer.
Management of spasticity in multiple sclerosis Francois A Bethoux
Eli Minkoff, Eli Baker in Multiple Sclerosis Therapeutics, 2007
Spasticity has been defined as a velocity-dependent increase in resistance to passive muscle stretching due to the exaggeration of tonic stretch reflexes1. Spasticity is frequently encountered in patients with multiple sclerosis (MS), often with significant consequences. In a prevalence study of 301 MS patients, 52% reported cramps, and 56.5% had increased tone on examination2. In a recently published survey of over 20 000 individuals with MS, only 16% of responders reported no spasticity, and approximately 33% reported moderate or severe spasticity, despite ongoing symptomatic treatment in a majority of these patients3. Disease-modifying therapies usually do not provide symptom relief, and there are even reports of increased spasticity with interferon β4. Although the pathophysiology of spasticity is incompletely understood, a wide array of symptomatic therapies are available to the clinician.
Management of spasticity in multiple sclerosis
Richard A. Rudick, Jeffrey A. Cohen in Multiple Sclerosis Therapeutics, 2004
Spasticity has been defined as a velocity-dependent increase in resistance to passive muscle stretching caused by the exaggeration of tonic stretch reflexes.[1] Spasticity is frequently encountered in multiple sclerosis (MS), often with significant subjective and objective consequences. In a prevalence study of 301 MS patients, 52% reported cramps, and 56.5% had increased tone on examination.[2] Disease-modifying therapies usually do not provide symptom relief, and there are even reports of increased spasticity with interferon beta.[3] Although the pathophysiology of spasticity is incompletely understood, a wide array of symptomatic therapies are available to the clinician.
Tetrahydrocannabinol and cannabidiol oromucosal spray in resistant multiple sclerosis spasticity: consistency of response across subgroups from the SAVANT randomized clinical trial
Published in International Journal of Neuroscience, 2020
Sven G Meuth, Thomas Henze, Ute Essner, Christiane Trompke, Carlos Vila Silván
Objective: To determine whether differences in disability status, spasticity severity, and spasticity duration at treatment start in patients with resistant multiple sclerosis (MS) spasticity might influence response to add-on tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (nabiximols) versus further re-adjustment of optimized first-line antispasticity medication. Methods: Using the database from the Sativex® as Add-on therapy Vs. further optimized first-line ANTispastics (SAVANT) study, this post hoc analysis evaluated spasticity severity (0-10 numerical rating scale [NRS] scores) and pain severity (0–10 NRS scores) evolution from randomization (baseline) to week 12 (end of double-blind treatment) in defined subgroups: Expanded disability status scale [EDSS] score subgroups (6), and spasticity duration subgroups (
Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2019
Jacqueline Tibbett, Eva G. Widerström-Noga, Christine K. Thomas, Edelle C. Field-Fote
Context/Objective: For persons with spinal cord injury, spasticity commonly interferes with activities of daily living such as transfers. Electromyography can be used to objectively measure muscle spasms during transfers, but how electromyographic measures relate to the impact spasticity has on life, or to clinically-rated spasticity, is unclear. We aimed to characterize relationships among spasm duration and magnitude, impact of spasticity on daily life, and a clinical measure of extensor spasticity, as well as to determine reliability of the electromyographic measures. Design: Participants (N=19) underwent electromyographic measurements of involuntary muscle activity (spasm duration and magnitude) evoked in quadriceps muscles during transfers on two days. Impact of spasticity on daily life was measured with the Spinal Cord Injury Spasticity Evaluation Tool. Clinically-rated spasticity severity was measured with the Spinal Cord Assessment Tool for Spastic reflexes. Results: No significant associations were found between impact of spasticity and spasm duration, spasm magnitude, or clinical extensor spasticity score. Absolute and normalized spasm duration were positively associated with clinical extensor spasticity score (rho=0.510-0.667, P
Pathophysiology, assessment and management of multiple sclerosis spasticity: an update
Published in Expert Review of Neurotherapeutics, 2011
Spasticity is one of the most common and disabling symptoms associated with multiple sclerosis (MS). MS spasticity occurs through both myelin and nerve fiber (axonal) degradation, which commence in the early stages of the disease. More than 80% of MS patients experienced spasticity in a large UK survey, with more than 50% of patients reporting their spasticity to be `moderate’ or `severe’. Data from a large US registry show that patients with moderate-to-severe MS spasticity experience levels of disability that correlate closely with being wheelchair-bound and/or bedridden. The Ashworth scale is the most commonly used scale for assessing the degree of MS spasticity. However, the validity, reliability and sensitivity of this scale have been challenged and it is not considered an ideal scale for assessing the severity of MS spasticity. The numerical rating scale, a well-established standard pain assessment tool, provides a reliable, valid and simplified scale for patient self-rated assessment of the mean level of spasticity over the previous 24 h (0 = no spasticity, 10 = worst possible spasticity). According to data from the German MS Register, almost a third of MS patients with spasticity were untreated. Despite the availability of oral agents for generalized spasticity (often used in conjunction with physical/rehabilitation management strategies), including baclofen, tizanidine, dantrolene and gabapentin, there is limited clinical evidence to support their use and there is a need for improved and better tolerated pharmacological therapies for MS spasticity. The endocannabinoid system modulator, Sativex® (nabiximols, USAN name), provides an alternative therapeutic approach in the management of MS spasticity.