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    Spasticity and Management

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    Masa Masa
    Spasticity is a condition characterized by involuntary muscle contractions that cause increased muscle tone or stiffness. It can arise from lesions in the brain or spinal cord that interfere with motor neuron activity. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes spasticity through damage to both upper and lower motor neurons, leading to muscle weakness, stiffness, and atrophy. Treatment for ALS focuses on managing symptoms like spasticity through drugs like riluzole that inhibit glutamate, as well as nutritional, respiratory, and mobility support. Tetanus also causes spasticity by producing a neurotoxin that prevents inhibitory neuronal transmission in the central nervous system, resulting in violent muscle spas

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    Spasticity and Management

    Uploaded by

    Masa Masa
    24 views15 pages
    Spasticity is a condition characterized by involuntary muscle contractions that cause increased muscle tone or stiffness. It can arise from lesions in the brain or spinal cord that interfere with motor neuron activity. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes spasticity through damage to both upper and lower motor neurons, leading to muscle weakness, stiffness, and atrophy. Treatment for ALS focuses on managing symptoms like spasticity through drugs like riluzole that inhibit glutamate, as well as nutritional, respiratory, and mobility support. Tetanus also causes spasticity by producing a neurotoxin that prevents inhibitory neuronal transmission in the central nervous system, resulting in violent muscle spas

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    11. Spasticity and Management (1)

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    Spasticity is a condition characterized by involuntary muscle contractions that cause increased muscle tone or stiffness. It can arise from lesions in the brain or spinal cord that interfere with motor neuron activity. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes spasticity through damage to both upper and lower motor neurons, leading to muscle weakness, stiffness, and atrophy. Treatment for ALS focuses on managing symptoms like spasticity through drugs like riluzole that inhibit glutamate, as well as nutritional, respiratory, and mobility support. Tetanus also causes spasticity by producing a neurotoxin that prevents inhibitory neuronal transmission in the central nervous system, resulting in violent muscle spas

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    24 views15 pages

    Spasticity and Management

    Uploaded by

    Masa Masa
    Spasticity is a condition characterized by involuntary muscle contractions that cause increased muscle tone or stiffness. It can arise from lesions in the brain or spinal cord that interfere with motor neuron activity. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes spasticity through damage to both upper and lower motor neurons, leading to muscle weakness, stiffness, and atrophy. Treatment for ALS focuses on managing symptoms like spasticity through drugs like riluzole that inhibit glutamate, as well as nutritional, respiratory, and mobility support. Tetanus also causes spasticity by producing a neurotoxin that prevents inhibitory neuronal transmission in the central nervous system, resulting in violent muscle spas

    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 15

    Spasticity

    PAC4462 Integrated Therapeutics – Neurology and


    Oncology

    FCHS 2022

    .
    fchs.ac.ae
    Spasticity
    Definition
    • Condition of performing involuntary contractile
    movements (ie. increased muscle tone)
    – Generalized rigidity (hypertonicity)

    • Arise from lesions interfering with motoneurone


    activity
    – Parkinsonism – lesions in basal ganglia
    – Cerebral palsy – lesions to parts of cortex
    – Rigidity on one (hemiplegia) or both sides of body
    – lesions to midbrain
    – Rigidity in muscles innervated below a lesion
    (monoplegia is the paralysis of any one limb) –
    damage to spinal cord
    2
    Spasticity
    Causes

    1.Multiple sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS) /


    Motoneurone disease

    2.Spinal cord injury: Birth, accident, chronic back pain

    3.Stroke, cerebral vascular disease (Covered already)

    4.Local injury or inflammation: eg. arthritis

    5.Cerebral palsy

    6.Tetanus

    3
    Amyotrophic Lateral Sclerosis (ALS)
    Moto-neurone disease

    • Motor neuron disease (UK) / Amyotrophic Lateral Sclerosis


    (ALS) (USA)
    • 50% of patients die within 18 months after diagnosis
    • Only 20% survive 5 years and 10% live longer than 10 years
    • Persons with ALS who go on a ventilator may live for many
    years. Improved treatment is allowing ALS patients to live
    longer than before.

    4
    Amyotrophic Lateral Sclerosis (ALS)
    Symptoms
    • tripping, stumbling and falling
    • loss of muscle control
    • loss of strength in hands and arms
    • difficulty speaking, swallowing and/or breathing
    • chronic fatigue
    • muscle twitching and/or cramping

    ALS is characterized by both upper and lower motor neuron


    damage. Symptoms of upper motor neuron damage include
    stiffness (spasticity), muscle twitching (fasciculations), and
    muscle shaking (clonus). Symptoms of lower motor neuron
    damage include muscle weakness and muscle shrinking
    (atrophy).

    5
    Amyotrophic Lateral Sclerosis (ALS)
    Diagnosis:
    Process of elimination - Findings inconsistent with ALS include:
    • Neuroimaging, EMG, clinical or other evidence of an alternative
    disease explaining signs or symptoms
    • Lack of progression to other body regions
    • Sphincter abnormalities
    • Sensory dysfunction
    • Visual decline, dementia
     Definite ALS
     LMN (lower motor neuron) and UMN (upper motor neuron) signs in three to four
    regions
     Evidence of progression
     Probable ALS
     LMN and UMN signs in at least two regions 
     Evidence of progression
     Possible ALS
     LMN and UMN in one region OR UMN in two regions
     LMN and UMN signs with no evidence of progression
     Suspected ALS
     LMN signs in two to three regions 6
    Amyotrophic Lateral Sclerosis (ALS)
    Causes
    • 10% of ALS cases appear to be hereditary
    • This is called familial ALS - defined as two or more cases in the
    same bloodline
    • Autosomal dominant, meaning that if a parent has ALS, their
    children have a 50% chance of inheriting the defective gene
    • While the risk of inheriting the defective gene is 50% for each
    child of an affected person, not all people with the defective gene
    will develop the disorder
    • Twenty percent of familial ALS cases have a specific gene defect
    in the SOD (super oxide dismutase) gene
    • 90% of ALS cases have no familial link, and they are called
    sporadic ALS.

    7
    Amyotrophic Lateral Sclerosis (ALS)
    Causes
    • ALS occurs in all races and all around the world.
    • Men get ALS more than women (1.5 to 1.0 ratio.)
    • The incidence of ALS is 2 per 100,000.
    • The average age of onset is 55 years.
    • 80% of ALS cases begin between the ages of 40 & 70.
    • Patients with ALS diagnosed between the ages of 20 and 40
    have a higher chance of surviving for 5 years. 

    8
    Amyotrophic lateral Sclerosis (ALS)

    British physicist:
    Dr Steven Hawking
    British actor: David Niven (8 January 1942 –
    14 March 2018

    Lou Gehrig
    Lou Gehrig’s
    Disease Diagnosed
    in 1939 and died in
    1941 aged 41.
    9
    Spasticity
    Amyotrophic Lateral Sclerosis (ALS):
    • Caused by oxidative stress due to accumulation of
    reactive oxygen species
    • Oxidative stress causes neurons to become more
    susceptible to excitotoxic damage

    • Fatal debilitating disease resulting from progressive


    degeneration of motor neurons
    • Following diagnosis, life expectancy is only 5 years

    • Defective superoxide dismutase (SOD).


    • SOD breaks down reactive oxygen species

    • Defective SOD leads to oxidative stress


    10
    Excitotoxicity
    Fig. 34.1
    Rang et al.

    Accumulation
    of reactive
    oxygen
    species
    which
    stimulates
    excitatory
    glutamate
    release
    leading to
    motor
    neurons
    excitation
    and muscles
    contraction

    11
    Amyotrophic Lateral Sclerosis (ALS)
    Treatment

    Riluzole
    • Inhibits release and postsynaptic action of
    glutamate
    • Slows excitotoxicity
    • Retards deterioration of patients with ALS
    • All patients are started on Riluzole at the time of
    diagnosis (British medical journal 2020)

    Amyotrophic lateral sclerosis - symptoms, diagnosis and treatment | BMJ best practice [online] Available
    from: https://bestpractice-bmj-com.ezproxy.rgu.ac.uk/topics/en-gb/330?q=Amyotrophic lateral
    sclerosis&c=suggested [Accessed 2/25/2020 2020]
    12
    Amyotrophic Lateral Sclerosis
    (ALS)
    • ALS is a progressive disease of the motor system and, as
    such, produces symptoms primarily relating to the location
    and degree of weakness.
    • The exact treatment needs are almost never identical from
    patient to patient and will change with time for individual
    patients.
    – Nutritional and respiratory support is critical, with the actual intervention
    required dependent on the status of the patient.
    – Those with significant weakness of bulbar musculature may require
    treatment for sialorrhoea, communication difficulties, and secretions.
    – Patients with weakness in the extremities may require treatment aimed
    at maintaining mobility, therapy for spasticity, or devices aimed at
    maintaining upper extremity function.
    – Mental status changes that may require treatment include depression
    and anxiety
    Amyotrophic lateral sclerosis - symptoms, diagnosis and treatment | BMJ best practice [online] Available from: 
    https://bestpractice-bmj-com.ezproxy.rgu.ac.uk/topics/en-gb/330?q=Amyotrophic lateral sclerosis&c=suggested [Accessed 2/25/2020
    Tetanus

    • Arises when a wound is contaminated with spores of


    Clostridium tetani (soil)
    • Bacilli multiply at site of infection and produce the protein
    neurotoxin: tetanospasmin
    • Toxin diffuses along axons of motoneurones to CNS
    • Interferes with inhibitory neuronal mechanisms by
    preventing release of transmitter

    14
    Effects of tetanus
    • Muscles become hypertonic
    • Violent reflex spasms to weak sensory stimuli
    • Lock-jaw
    • Death occurs as a consequence of spastic paralysis of
    respiratory muscles

    Treatment of tetanus:
    • Artificial ventilation of lungs
    • Prolonged use of muscle relaxants:
    • Protection for 5-10 years by immunization with
    tetanus toxoid
    15

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