Spasticity in Prolonged Disorders of Consciousness: A Prospective Cohort Study

Area of Science:

• Neurology
• Rehabilitation Medicine
• Neuroscience

Background:

• Spasticity is a common and debilitating issue for patients with prolonged disorders of consciousness (PDOC).
• Understanding spasticity's prevalence, patterns, and progression in PDOC is crucial for effective management.
• Current knowledge on spasticity's relationship with consciousness recovery in PDOC is limited.

Purpose of the Study:

• To determine the prevalence, severity, and distribution of spasticity in PDOC patients during early intensive neurorehabilitation (EIN).
• To track the evolution of spasticity throughout EIN.
• To explore associations between spasticity, clinical factors, and level of consciousness (LOC) recovery.

Main Methods:

• Prospective cohort study (DOCTOR) including 126 PDOC patients undergoing EIN.
• Spasticity assessed using the Ashworth Scale (AS) across seven muscle groups at admission and discharge.
• Statistical analyses explored correlations between spasticity and demographic, clinical, and consciousness variables.

Main Results:

• High spasticity prevalence at admission (88%) and discharge (90%), typically bilateral and widespread.
• Elbow flexors, wrist flexors, hip adductors, and knee flexors were most affected.
• Spasticity severity increased from admission (19% severe) to discharge (30% severe) and correlated with pain and spasmolytic use, but not LOC.

Conclusions:

• Spasticity is nearly universal and can progress in PDOC patients even with specialized neurorehabilitation.
• Spasticity's evolution appears unrelated to consciousness recovery, necessitating its management as a separate clinical issue.
• Further interventional studies are needed to optimize spasticity treatment strategies in PDOC.