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Physiologic and pharmacologic approaches to spasticity.

R R Young1

  • 1Harvard Medical School, Boston, Massachusetts.

Neurologic Clinics
|November 1, 1987
PubMed
Summary

Spasticity encompasses diverse syndromes with unclear pathophysiology. Functional disability in spastic paresis often stems from negative symptoms, not spasticity itself, necessitating tailored neurophysiologic assessment and varied therapeutic strategies.

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Area of Science:

  • Neurology
  • Neurophysiology
  • Rehabilitation Medicine

Background:

  • Spasticity is a complex clinical syndrome with poorly understood pathophysiological mechanisms, leading to varied definitions and treatment approaches.
  • Existing definitions of spasticity fail to capture the diversity of underlying conditions, hindering effective therapeutic development.
  • Functional disability in spastic paresis is often attributed to negative symptoms rather than spasticity itself.

Purpose of the Study:

  • To clarify the definition and pathophysiology of spasticity.
  • To highlight the role of neurophysiological techniques in classifying spasticity subtypes.
  • To review current therapeutic strategies for managing spasticity.

Main Methods:

  • Review of existing literature on spasticity pathophysiology and clinical presentation.
  • Analysis of neurophysiological techniques for patient categorization.
  • Evaluation of pharmacological and non-pharmacological treatment modalities.

Main Results:

  • Spasticity comprises multiple unrelated syndromes with limited shared pathophysiological mechanisms.
  • Clinical neurophysiology aids in subgrouping patients with similar clinical presentations but different treatment responses.
  • Evidence does not support fusimotor or spindle primary afferent hyperactivity in spastic patients; reduced central inhibition likely causes hyper-reflexia.
  • Increased passive muscle stiffness is a clinically significant factor.

Conclusions:

  • A unified definition of spasticity is not currently feasible due to its heterogeneous nature.
  • Neurophysiological assessment is crucial for tailoring therapies to specific spasticity subgroups.
  • Management strategies include addressing causative factors, physical therapy, surgery, and pharmacotherapy (e.g., dantrolene, baclofen, diazepam).

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