spasticity treatment options

While there is currently no cure for severe spasticity, people with spasticity can be treated in a variety of ways, including:

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PHYSICAL THERAPY

With physiotherapy, ergotherapy and logopedics, you can train your brain to relearn some abilities.

Used alone or alongside conventional and advanced treatments.

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Oral Medication

Oral medication can lower the burden caused by spasticity. For severe disabling spasticity, oral medication should be used at high dosage, which can cause intolerable side effects.

Used until not effective any more or creates intolerable side effects.1

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INJECTIONS

Injection of neurolytic agents (phenol and alcohol). Spasticity can also be treated with botulinum toxin injections. This is a neurotoxin that interferes with muscle contract process and can reduce muscle tone for about three months.2

Generally used for focal spasticity (i.e., in one limb only).

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SURGERY

Surgery is a non-reversible intervention that may be applied to affect nerves (e.g., selected dorsal rhizotomy, neurotomy) or bones (e.g., osteotomies, fusions) or muscle and tendon (e.g., lengthening transfer).

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INTRATHECAL BACLOFEN THERAPY

If the spasticity affects more than one extremity and you have already tried other treatment options without a satisfying effect or with too many side effects, then intrathecal baclofen therapy can help you to lower the burden caused by spasticity and increase your function and quality of life.3-13

TREATMENT OPTIONS CAN BE COMBINED TO REACH THE BEST POSSIBLE OUTCOME

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Treating
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1

Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen. J Rehabil Med. 2017;49:193–203.

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Elia AE et al. Botulinum neurotoxins for post-stroke spasticity in adults: a systematic review. Mov Disord. 2009 Apr 30;24(6):801-12.

3

Ramstad K, Jahnsen R, Lofterod B, Skjeldal OH. Continuous intrathecal baclofen therapy in children with cerebral palsy – when does improvement emerge? Acta Paediatr. 2010;99(11):1661–1665.

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Motta F, Antonello CE, Stignani C. Intrathecal baclofen and motor function in cerebral palsy. Dev Med Child Neurol. 2011;53(5):443–448.

5

Vles GF, Soudant DL, Hoving MA et al. Long-term follow-up on continuous intrathecal baclofen therapy in non-ambulant children with intractable spastic cerebral palsy. Eur. J. Paediatr Neurol. 2013;17(6):639-644.

6

Guillaume D., Van Havenbergh A., Vloeberghs M., Vidal J., Roeste G. A clinical study of intrathecal baclofen using a programmable pump or intractable spasticity. Arch Phys Med Rehabil. 2005;86(11):2165-71.

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Hoving MA, van Raak EP, Spincemaille GH et al; Dutch Study Group on Child Spasticity. Safety and one-year efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy. Eur J Paediatr Neurol. 2009; May;13(3):247-56.

8

Schiess MC, Oh IJ, Stimming EF et al. Prospective 12-month study of intrathecal baclofen therapy for poststroke spastic upper and lower extremity motor control and functional improvement. Neuromodulation. 2011;14(1):38-45.

9

Ivanhoe CB, Francisco GE, McGuire JR et al. Intrathecal baclofen management of poststroke spastic hypertonia: implications for function and quality of life. Arch Phys Med Rehabil. 2006;87(11):1509-1515.

10

Creamer et al. Effect of intrathecal baclofen on pain and quality of life in poststroke spasticity: A randomized trial (SISTERS). Stroke. 2018;49:2129–2137.

11

Delhaas EM. Long-term outcomes of continuous intrathecal baclofen infusion for treatment of spasticity: A prospective multicenter follow-up study. Neuromodulation. 2008;11(3):227-236.

12

Natale M, D’Oria S, Nero VV, Squillante E, Gentile M, Rotondo M. Long-term effects of intrathecal baclofen in multiple sclerosis. Clin Neurol Neurosurg. 2016;143:121-5.

13

Rawicki B. Continuous intrathecal baclofen delivered via an implantable pump: long-term follow-up review of 18 patients. J Neurosurg. 1999;91(5):733-736.