The treatment of stroke patients has seen several advances in recent years and among the most significant are therapies for a post-stroke stiffness in arm and leg called spasticity. A common physical response to brain injury caused by stroke, spasticity causes muscles in the arms or legs to tighten uncontrollably, causing pain and discomfort. Left untreated, spasticity can have a profound impact on an individual’s quality of life.
What is spasticity?
Spasticity is a resistance in the muscles to stretch after an injury to the central nervous system. That injury can be the result of a stroke, multiple sclerosis, tumors, etc.
What are the symptoms of this condition? What does it actually do to those who suffer from it?
When patients have spasticity, they may have a fixed clenching of their hand, or flexion of their fist. They may have trouble getting their arm away from their body so that it’s difficult to clean under their arm. They may have abnormal posture. Patients may try to walk, but their feet want to turn inward. You may see patients whose legs will cross each other when you try to transfer them or when you try to clean them. Those are some of the things that you’ll see in spasticity.
What are the long-term effects of this condition?
The type of recovery patients can have over time will be limited by spasticity if they don’t receive appropriate treatment for it. They can have pain associated with their spasticity, or pain associated with attempts to move their joints. If we don’t try to move their joints, they’ll have more pain over time.
Some spasticity is focal, and some is more generalized. How are they different?
Focal spasticity affects a smaller part of the body, such as a hand or an extremity. Generalized spasticity affects greater areas of the body.
What are the traditional treatments for spasticity?
Many people will start the treatment of spasticity with oral medications, which can relax the affected muscles that are causing the spasticity. The oral medications that are most commonly used for spasticity are oral baclofen (Liofen, Baclof), tolperisone, thiocolchiside and tizanidine.
But oral medications will very often cause sedation in patients, or lethargy. They may also increase their confusion.
The medications also will affect their entire body, so if you’re trying to target specific muscles, it makes little sense to give medications that affect the whole body.
Are there any new treatment alternatives for focal spasticity?
For focal spasticity, I generally use botulinum toxin A, or Botox, because it’s a way to target smaller areas with injections rather than treating people with medications that will involve systemic side effects.
Botox injections have a positive impact in treating patients with focal spasticity. Botox is one of the first really effective, new treatments that we’ve had for focal spasticity in decades.
How does BOTOX work?
Botox works by entering nerve endings around the muscle where it is injected, and blocking the release of chemical messages that cause the muscle to contract. It allows us to target specific muscles. There are no sedating side effects.
What are its known side effects?
It has a really low side-effect profile. Patients may have a little bit of bleeding at the site of an injection. They may have a little bit of tenderness during the injection which disappears soon after injection. Some patients have had some flu-like symptoms for a while following an injection, but overall, the side effect profile is quite limited.
How long does the effect of a Botox injection last?
On the average, Botox injections last approximately three to six months.
What is the cost of BOTOX therapy?
A vial of BOTOX is available @ Rs 16,500 M.R.P. A person might need 1-3 vials per sitting depending on the number of muscles involved.