Book contents
- Frontmatter
- Contents
- List of Contributors
- 1 Introduction
- 2 Mechanistic basis for the therapeutic effectiveness of botulinum toxin A on over-active cholinergic nerves
- 3 Botulinum toxin: from menace to medicine
- 4 Botulinum toxin: primary and secondary resistance
- 5 Introduction to botulinum toxin in clinical practice
- 6 Cervical dystonia
- 7 The use of botulinum toxin in otolaryngology
- 8 Spasticity
- 9 Hyperhidrosis
- 10 Hypersalivation
- 11 Botulinum toxin type A for the prophylactic treatment of primary headache disorders
- 12 Botulinum toxin in the management of back and neck pain
- 13 Clinical uses of botulinum toxin
- 14 Bladder and bowel indications
- 15 Cosmetic uses of botulinum toxin A
- 16 Other clinical neurological uses of botulinum toxin
- Index
- Plate section
- References
8 - Spasticity
Published online by Cambridge University Press: 02 December 2009
Book contents
- Frontmatter
- Contents
- List of Contributors
- 1 Introduction
- 2 Mechanistic basis for the therapeutic effectiveness of botulinum toxin A on over-active cholinergic nerves
- 3 Botulinum toxin: from menace to medicine
- 4 Botulinum toxin: primary and secondary resistance
- 5 Introduction to botulinum toxin in clinical practice
- 6 Cervical dystonia
- 7 The use of botulinum toxin in otolaryngology
- 8 Spasticity
- 9 Hyperhidrosis
- 10 Hypersalivation
- 11 Botulinum toxin type A for the prophylactic treatment of primary headache disorders
- 12 Botulinum toxin in the management of back and neck pain
- 13 Clinical uses of botulinum toxin
- 14 Bladder and bowel indications
- 15 Cosmetic uses of botulinum toxin A
- 16 Other clinical neurological uses of botulinum toxin
- Index
- Plate section
- References
Summary
Introduction
Spasticity is a physiological consequence of an insult to the brain or spinal cord, which can lead to life-threatening, disabling and costly consequences. This typically occurs in the following patients following stroke, brain injury (trauma and other causes, e.g. anoxia, post-neurosurgery), spinal cord injury, multiple sclerosis and other disabling neurological diseases, and cerebral palsy. Its current management has been advanced considerably over the last ten years by new thinking and by new drugs and technology. Lance's definition of 1980 is still relevant and the impairment is classified as one of the movement disorders. It is important therefore to stress when teaching on this topic, in order to highlight the need for patients' spasticity to be assessed while they are functioning. The fact that many attempts have been made to define it shows the degree of its complexity, but Young described spasticity as part of the upper motor neuron syndrome and gave a definition as a velocity-dependent increase in muscle tone with exaggerated tendon jerks resulting in hyper-excitability of the stretch reflex in association with other features of the upper motor neuron syndrome.
He also described spastic dystonia and spastic paresis, which are somewhat contentious terms, but do highlight the positive and negative features of the upper motor neuron syndrome and these are set out in Table 8.1. Essentially, if left untreated following damage to the brain or spinal cord, it is characterized by muscle overactivity and high-tone spasms and will lead to muscle and soft tissue contracture.
- Type
- Chapter
- Information
- Clinical Uses of Botulinum Toxins , pp. 122 - 174Publisher: Cambridge University PressPrint publication year: 2007
References
Lance, J. W. (1980). Symposium synopsis. In , , and , eds., Spasticity: Disordered Control. Chicago: Yearbook Medical, pp. 485–94.Google Scholar
(2002). Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion. InSpasticity: Etiology, Evaluation, Management and the Role of Botulinum Toxin. New York: We Move, pp. 1–10.Google Scholar
A European Thematic Network to Develop Standardised Measures of Spasticity (SPASM). CREST – Centre for Rehabilitation and Engineering Studies, University of Newcastle, Stephenson Building, Claremont Road, Newcastle upon Tyne, NE1 7RU, UK.
(1966). The Cerebral Control of Movement. Liverpool: Liverpool University Press, pp. 124–43.Google Scholar
, , and (2002). Traditional pharmacological treatments for spasticity. Part I: Local treatments. In Spasticity: Etiology, Evaluation, Management and the Role of Botulinum Toxin. New York: We Move, pp. 44–64.Google Scholar
, , and (1997). Stretched position of spastic muscle aggravates their co-contraction in hemiplegic patients. Annals of Neurology, 42(30), 438.Google Scholar
(1999). Botulinum toxin in spasticity management. British Journal of Therapy and Rehabilitation, 6(7), 26–34.CrossRefGoogle Scholar
, , , and (1972). Physiological and structural changes in cat soleus muscle due to immobilization at different lengths by plaster casts. Journal of Physiology, 224, 231–44.Google Scholar
and (1998). Sprouting of primary afferent fibres after spinal cord transection in the rat. Neuroscience, 85, 443–58.CrossRefGoogle Scholar
, , and (1991). Plasticity of central motor pathways in children with hemiplegic cerebral palsy. Neurology, 15045–110.Google ScholarPubMed
(1966). In The Cerebral Control of Human Movement. Liverpool: Liverpool University Press, pp. 124–43.Google Scholar
New standards for nurses to boost patient care. Department of Health Report 0096 (2001). HMSO, London.
Fully Equipped: The Provision of Equipment to Older or Disabled People by the NHS and Social Services in England and Wales Audit Commission (2000). HMSO, London.
, , , and (2005). A randomized controlled trial of the management of early lower limb spasticity following acute acquired severe brain injury. Clinical Rehabilitation, 19(2), 117–125.CrossRefGoogle Scholar
and (1987). Epidemiology of some neurological diseases, with special reference to work load in the NHS. International Rehabilitation Medicine, 8, 129–37.CrossRefGoogle ScholarPubMed
Rehabilitation after traumatic brain injury: a Working Party Report of the British Society of Rehabilitation Medicine (1998). London: British Society of Rehabilitation Medicine.
Neurological rehabilitation – a working party report (Chairman, Barnes M. P.) of the British Society of Rehabilitation Medicine and the Neurological Alliance (1992). London: British Society of Rehabilitation Medicine.
, , , , , and (2000). Evaluating the role of botulinum toxin in the management of focal hypertonia in adults. Journal of Neurology, Neurosurgery and Psychiatry, 69, 499–506.CrossRefGoogle ScholarPubMed
(Chairman) et al. (2001). Working party report on the management of adult spasticity using botulinum toxin type A – a guide to clinical practice. Byfleet: Radius Healthcare.
, , and (1988). For how long must the soleus muscle be stretched each day to prevent contracture?Developmental Medicine and Child Neurology, 30, 3–10.CrossRefGoogle ScholarPubMed
Ward, A. B. and KoKo, C. (2001). Pharmacological management of spasticity. In and , eds., Chapter in Clinical Management of Spasticity. London, Cambridge: Cambridge University Press, pp. 165–87.Google Scholar
(2000). Functional rewiring of brain and spinal cord after injury: the three Rs of neural repair and neurological rehabilitation. Current Opinion in Neurology, 13(6), 655–8.CrossRefGoogle ScholarPubMed
, , , , and (1986). Botulinum type B. Its purification, radio-iodination, and interaction with rat brain synaptosomal membranes. European Journal of Biochemistry, 154, 409–16.CrossRefGoogle Scholar
and (1982). Binding to mouse brain synaptosomes of Clostridium botulinum type E derivative toxin before and after tryptic activation. Toxicon, 20, 841–6.CrossRefGoogle Scholar
and (1989). Baclofen, gamma-aminobutyric acid B receptors and substance P in the mouse spinal cord. Journal of Pharmacology and Experimental Therapy, 248, 1026–33.Google Scholar
, , and (1984). Are baclofen-sensitive GABA-B receptors present on primary afferent terminals of the spinal cord?Nature, 307, 71–3.CrossRefGoogle Scholar
, , , and (1993). Clinical and pharmacokinetic aspects of high dose baclofen therapy. Journal of American Paraplegia Society, 15, 211–16.CrossRefGoogle Scholar
, and (1974). The mode of action of the GABA derivative baclofen in human spasticity. Acta Neurologica Scandinavia, 50, 665–80.CrossRefGoogle Scholar
and (1971). Baclofen in the treatment of spasticity. British Medical Journal, 4, 155–7.CrossRefGoogle ScholarPubMed
and (1975). A double blind trial with baclofen (Lioresal) and diazepam in spasticity due to multiple sclerosis. Acta Neurologica Scandinavia, 51, 158–66.CrossRefGoogle ScholarPubMed
Whyte, J. and Robinson, K. M. (1990). Pharmacologic management. In and , eds., The Practical Management of Spasticity in Children and Adults. Philadelphia: Lea & Febiger, pp. 201–26.Google Scholar
, , and (1977). Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. Drugs, 13, 3–23.CrossRefGoogle ScholarPubMed
, , and (1977). Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. Drugs, 13, 3–23.CrossRefGoogle ScholarPubMed
, and (1971). The effects of dantrolene sodium on spasticity and motor performance in hemiplegia. Southern Medical Journal, 64(2), 180–5.CrossRefGoogle ScholarPubMed
and (1984). Long-term treatment with dantrolene sodium of stroke patients with spasticity limiting the return of function. Current Medical Research and Opinion, 9(3), 161–8.CrossRefGoogle ScholarPubMed
, , and (1992). Objective assessment of spasticity, strength, and function with early exhibition of dantrolene sodium after cerebrovascular accident: a randomized double-blind controlled study. Archives of Physical Medicine and Rehabilitation, 73, 4–8.Google Scholar
, , et al. (1978). Dantrolene sodium in the treatment of spasticity in chronic spinal cord disease. Practitioner, 221, 123–7.Google ScholarPubMed
and (1973). The effect of dantrolene sodium on spasticity in multiple sclerosis. Neurology, 23, 1313–15.CrossRefGoogle ScholarPubMed
, and . (1975). Treatment of spasticity in multiple sclerosis with dantrolene. Journal of American Medical Association, 233(10), 1046.CrossRefGoogle ScholarPubMed
, and (1979). Dantrolene-associated hepatic injury: incidence and character. Gastroenterology, 72, 610–16.Google Scholar
and (1984). Pneumonitis, pleural effusion and pericarditis following treatment with dantrolene. Journal of Neurology, Neurosurgery and Psychiatry, 47(5), 553–4.CrossRefGoogle ScholarPubMed
, , et al. (1994). Tizanidine treatment of spasticity caused by multiple sclerosis: results of a double-blind, placebo-controlled trial. Neurology, 44(Suppl. 9), S34–S43.Google ScholarPubMed
, , et al. (1994). Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. Neurology, 44(Suppl. 9), S44–S52.Google ScholarPubMed
The United Kingdom Tizanidine Trial Group. (1994). A double-blind, placebo-controlled trial of tizanidine in the treatment of spasticity caused by multiple sclerosis. Neurology, 44(Suppl. 9), S70–S78.
and (1980). Double-blind comparison of single doses of DS103–282, baclofen, and placebo for suppression of spasticity. Journal of Neurology, Neurosurgery and Psychiatry, 43, 1132–6.CrossRefGoogle ScholarPubMed
, and (1981). A double-blind comparative trial of a new muscle relaxant, tizanidine and baclofen in the treatment of chronic spasticity in multiple sclerosis. Current Medical Research and Opinion, 7, 374–83.Google ScholarPubMed
, , et al. (1982). Tizanidine in the treatment of spasticity. European Journal of Clinical Pharmacology, 23, 31–5.CrossRefGoogle ScholarPubMed
, , and (1987). The treatment of spasticity in multiple sclerosis: a double-blind clinical trial of a new anti-spasticity drug tizanidine compared with baclofen. Acta Neurologica Scandinavia, 75, 190–4.CrossRefGoogle Scholar
, , et al. (1988). A multi-centre, double-blind trial of tizanidine, a new antispastic agent, in spasticity associated with hemiplegia. Current Medical Research and Opinion, 10, 709–18.CrossRefGoogle ScholarPubMed
and (1997). Tizanidine: a review of its pharmacology, clinical efficacy and tolerability in the management of spasticity associated with cerebral and spinal disorders. Drugs, 53(3), 435–52.CrossRefGoogle ScholarPubMed
(1994). Summary of combined clinical analysis of controlled clinical trial with tizanidine. Neurology, 44 (Suppl. 9), S60–8.Google ScholarPubMed
, and (1996). A case of tizanidine-induced hepatic injury. Journal of Hepatology, 25, 772–3.CrossRefGoogle ScholarPubMed
(1985). Antispasticity drugs: mechanisms of action. Annals of Neurology, 17, 107–16.CrossRefGoogle ScholarPubMed
Ketelaer, C. J. and Ketelaer, P. (1971). The use of Lioresal in the treatment of muscular hypertonia due to multiple sclerosis: spasticity: a topical survey. In , ed., An International Symposium, Vienna. Vienna: Huber, pp. 128–31.Google Scholar
and (1977). Clonazepam, baclofen and placebo in the treatment of spasticity. European Journal of Neurology, 16, 257–62.CrossRefGoogle ScholarPubMed
, and (2004). Cannabinoids in multiple sclerosis: do they have a therapeutic role?Drugs, 64(1), 1–11.CrossRefGoogle ScholarPubMed
, , , , , and (2003). UK MS Research Group. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multi-centre randomized placebo-controlled trial. Lancet, 362(9395), 1517–26.CrossRefGoogle Scholar
, , and (1984). Cancer pain relief using chronic morphine infusion; early experience with a programmable drug pump. Journal of Neurosurgery, 61(2), 302–6.CrossRefGoogle ScholarPubMed
and (1985). Continuous intrathecal baclofen for severe spasticity. Lancet, ii(8447), 125–7.CrossRefGoogle Scholar
, and (1986). Reversible coma due to intrathecal baclofen. Lancet, i(8508), 696.CrossRefGoogle Scholar
and (1987). Long-term intrathecal baclofen infusion for treatment of spasticity. Journal of Neurosurgery, 66(2), 181–5.CrossRefGoogle ScholarPubMed
, , , , , and (2002). Long-term safety and efficacy of continuous intrathecal baclofen. Developmental Medicine and Child Neurology, 44(10), 660–5.CrossRefGoogle ScholarPubMed
and (1995). Complications associated with infusion pumps implanted for spasticity. Stereotactic and Functional Neurosurgery, 65(1–4), 147–51.CrossRefGoogle ScholarPubMed
(2000). Selective block of late Na (+) current by local anaesthetics in rat large sensory neurons. British Journal of Pharmacology, 129(8), 1617–20.CrossRefGoogle Scholar
(1959). Intrathecal phenol to relieve spasticity in paraplegia. Lancet, ii, 1099–102.CrossRefGoogle Scholar
and (1959). Intrathecal phenol in the treatment of reflex spasms and spasticity. Lancet, ii, 1102–5.CrossRefGoogle Scholar
, and (1965). Effects of phenol solution on the nerve roots of the cat: an electrophysiological and histological study. Journal of Neurological Science, 2, 7–28.CrossRefGoogle ScholarPubMed
and (1970). Effect of phenol injection on peripheral nerve of rat: electron microscope studies. Archives of Physical Medicine and Rehabilitation, 51, 391–7.Google ScholarPubMed
, , and (1964). Management of spasticity by selective peripheral nerve block with dilute phenol solutions in clinical rehabilitation. Archives of Physical Medicine and Rehabilitation, 45, 513–18.Google ScholarPubMed
(1993). The effects of 2 per cent and 5 per cent aqueous phenol on the cat tibial nerve in situ. Masui, 42(6), 819–25.Google Scholar
(1977). Histological studies in animals after intramuscular neurolysis with phenol. Archives of Physical Medicine and Rehabilitation, 58, 448–53.Google Scholar
, , and (1998). Comparison of phenol block and botulinum toxin type A in the treatment of spastic foot after stroke: a randomized double-blind trial. American Journal of Physical and Rehabilitation Medicine, 77(6), 510–15.CrossRefGoogle ScholarPubMed
, and (1996). Time course of muscle atrophy and recovery following a phenol-induced nerve block. Muscle and Nerve, 19(4), 497–504.CrossRefGoogle ScholarPubMed
Glenn, M. B. (1990). Nerve blocks. In and , eds., The Practical Management of Spasticity in Children and Adults. Philadelphia: Lea & Febiger, pp. 227–58.Google Scholar
(1983). Venous thrombosis resulting from phenol injectionsJournal of the American Medical Association, 249(14), 1807.CrossRefGoogle Scholar
(2004). Physiological effects of botulinum toxin in spasticity. Movement Disorders, 19(Suppl. 8), S120–8.CrossRefGoogle ScholarPubMed
(1997). Dosing, administration, and a treatment algorithm for use of botulinum toxin A for adult-onset spasticity. Spasticity Study Group. Muscle and Nerve, 20(Suppl. 6), S208–20.3.0.CO;2-1>CrossRefGoogle Scholar
, , and (1994). Histologic assessment of dose related diffusion and muscle fibre response after therapeutic botulinum A toxin injections. Movement Disorders, 9, 31–8.CrossRefGoogle Scholar
, and (1997). Automatic-guided botulinum toxin treatment of spasticity. Clinical Neuropharmacology, 3, 195–203.CrossRefGoogle Scholar
, , and (1996). Comparison of two injection techniques in spastic hemiplegia. American Journal of Physical Medicine and Rehabilitation, 75, 462–8.CrossRefGoogle ScholarPubMed
(1996). In eds., Neurological Physiotherapy: a Problem Solving Approach. London: Churchill Livingstone, pp. 45–7.Google Scholar
, , , , and (1999). A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity. Clinical Rehabilitation, 13, 373–83.CrossRefGoogle ScholarPubMed
, and (1954). A la recherche d'une technique de mesure de la spasticité. Revue Neurologique, 91, 143–4.Google Scholar
Johnson, G. R. (2001). Measurement of spasticity In and , eds., Upper Motor Neuron Syndrome and Spasticity: Clinical Management and Neurophysiology. Cambridge: Cambridge University Press, pp. 79–95.Google Scholar
(1964). Preliminary trial of carisprodal in multiple sclerosis. Practitioner, 192, 540–2.Google ScholarPubMed
, , , and (1992). Inter-rater reliability of the modified Ashworth scale for spasticity in hemiplegic patients. International Journal of Rehabilitation Research, 15, 158–61.CrossRefGoogle ScholarPubMed
, , and (1989). The Ashworth scale: a reliable and reproducible method of measuring spasticity. Journal of Neurological Rehabilitation, 3, 205–8.Google Scholar
, and (1996). Spasticity and muscle contracture following stroke. Brain, 119, 1737–48.CrossRefGoogle ScholarPubMed
and (1987). Inter-rater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy, 67, 206–27.CrossRefGoogle Scholar
, , , , , , and (2000). The unreliability of clinical measures of muscle tone: implications for stroke therapy. Age and Ageing, 29(3), 229–33.CrossRefGoogle Scholar
, , , , and (2000). Reliability of measurements of muscle tone and muscle power in stroke patients. Age and Ageing, 29(3), 223–8.CrossRefGoogle ScholarPubMed
, , and (1998). Evaluation of reflex and non-reflex induced muscle resistance to stretch in adults with spinal cord injury using hand-held and isokinetic dynamometry. Physical Therapy, 78, 964–77.CrossRefGoogle Scholar
and (1969). Rééducation motrice des affections neurologiques. Paris: J B Bailière et Fils, pp. 31–42.Google Scholar
and (1999). Objective measurement of clinical findings in the use of botulinum toxin type A in the management of spasticity in children with cerebral palsy. European Journal of Neurology, 6(4), S23–S36.CrossRefGoogle Scholar
(2001). Evaluation de la spasticité. Apport de l'echelle de Tardieu. Motricité Cérébrale, 22, 1–16.Google Scholar
and (1994). Mechanism of spastic hypertonia. Physical Medicine and Rehabilitation, 8, 441–54.Google Scholar
, , and (1994). Objective quantification of spastic hypertonia: correlation with clinical findings. Archives of Physical Medicine and Rehabilitation Medicine, 73(4), 339–47.CrossRefGoogle Scholar
, , , , , , , and (1996). Botulinum toxin type A in the treatment of upper extremity spasticity; a randomised, double-blind, placebo-controlled trial. Neurology, 46, 1306–10.CrossRefGoogle Scholar
, , et al. (2000). A randomised, double-blind, dose ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) in the treatment of upper limb spasticity after stroke. Stroke, 31(10), 2402–6.CrossRefGoogle Scholar
, , and (2000). Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised, double-blind, placebo-controlled trial. Journal of Neurology, Neurosurgery and Psychiatry, 69, 217–28.CrossRefGoogle Scholar
, , , , , , , and , Botox Post-Stroke Spasticity Study Group (2002). Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. New England Journal of Medicine, 347(6), 395–400.CrossRef
, , , , , , , , , , and (2002). Inter- and intra-rater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb post-stroke spasticity. Archives of Physical Medicine and Rehabilitation, 83(10), 1349–54.CrossRefGoogle Scholar
(1992). Measurement in Neurological Rehabilitation, Oxford: Oxford University Press.Google ScholarPubMed
(1981). A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int. J. Rehabil. Res., 4, 483–92.CrossRefGoogle ScholarPubMed
, , , , and (2002). Are we underestimating the clinical efficacy of botulinum toxin (type A)? Quantifying changes in spasticity, strength and upper limb function after injections of Botox® to the elbow flexors in a unilateral stroke population. Clinical Rehabilitation, 16(6), 654–60.CrossRefGoogle ScholarPubMed
(1999). Use of botulinum toxin type A in spastic diplegia resulting from cerebral palsy. European Journal of Neurology, 6(Suppl. 4), S46–S48.CrossRefGoogle Scholar
(2002). Clinical trials of botulinum toxin in the treatment of spasticity. In Spasticity: Etiology, Evaluation, Management and the Role of Botulinum Toxin. New York: We Move, pp. 125–30.Google Scholar
and (2002). The management of adult spasticity using botulinum toxin type A – a guide to clinical practice. Clinical Medicine, 2(2), 128–30.CrossRefGoogle Scholar
(2002). Botulinum toxin A (BoNT-A) for spasticity in adults. What is the evidence?European Journal of Neurology, 9(Suppl. 1), 42–7.CrossRefGoogle ScholarPubMed
(2001). Botulinum treatment of spasticity: why is it so difficult to show a functional benefit?Current Opinion in Neurology, 14(6), 771–6.CrossRefGoogle ScholarPubMed
, and (2000). Anti-spasticity agents for multiple sclerosis. Cochrane Database of Systematic Reviews, 4, CD001332.Google Scholar
, , , and (1998). Low dose botulinum toxin with ankle taping for the treatment of spastic equinovarus foot after stroke. Archives of Physical Medicine and Rehabilitation, 79, 532–5.CrossRefGoogle ScholarPubMed
, , , , , , , , and (1996). A randomised double-blind placebo-controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients. Journal of Neurology, Neurosurgery and Psychiatry, 61, 265–8.CrossRefGoogle ScholarPubMed
Simpson, D. et al. Placebo-controlled double-blind trial of BOTOX® (botulinum toxin type A) versus ZanafleX® (tizanidine) for the treatment of upper limb spasticity. Personal communication.
, , , , , , , , , , , and (2000). Botulinum toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. Journal of Neurology, Neurosurgery and Psychiatry, 68(6), 707–12.CrossRefGoogle ScholarPubMed