Article

This educational paper aims to describe, in adult patients, the
different aspects of muscle overactivity after a central nervous system lesion,
including spasticity, spastic dystonia and spastic co-contraction, the assessment
of their symptoms and consequences, and therapeutic options. Clinical evaluation involves the assessment of passive range of
motion, angle of catch or clonus, active range of motion, rapid alternating
movements and functional consequences. A number of scales have been developed to
assess patients with spastic paresis, involving both patient and caregivers. Not
all persons with spasticity require treatment, which is considered only when
muscle overactivity is disabling or problematic. A list of personal objectives
may be proposed for each patient, which will drive assessment and treatment.
Prior to treatment the patient must be informed of the intended benefits and
possible adverse events. Clinical evaluation may be supported by the use of
transient neuromuscular blocks and/or instrumental analysis. Physical therapies
usually represent the mainstay of treatment. Self-rehabilitation with stretching
and active exercises, intramuscular injections of botulinum toxin, alcohol or
phenol injections, oral or intrathecal drugs, and surgery comprise the treatment
options available to the clinician. Follow-up must be scheduled in order to
assess the benefits of treatment and possible adverse events.

Langue : ANGLAIS