What is muscle spasticity and how to get rid of it? Such questions are especially relevant in patients suffering from it and doctors. This is a condition where the muscles contract too intensely during their rapid stretching. In patients, muscle strength is often reduced, voluntary control of movements is lost, up to paralysis.
Why muscle spasticity occurs
The main answer to this question lies in the imbalance of impulses following from the brain to the muscles.
Other causes of muscle spasticity are:
- Mutilation of the brain (both spinal and brain).
- Strokes.
- Infectious diseases in which inflammatory processes affect the brain, such as meningitis.
- Hypoxia is a pathology that occurs due to oxygen deficiency.
- Amyotrophic lateral sclerosis.
Categories of Violations
In the classification of muscle spasticity there are only three of them:
- Flexor. Flexor muscles are characterized by an increased tone when bending and raising arms or legs in joints.
- Extenous. A similar picture with item 1, only the process occurs in the extensor muscles.
- Adductor. The tone develops when the knees close and the legs cross in the lower leg area.
Central paresis
With this disease, spasticity develops due to a reduction in inhibitory effects (TB) on spinal neurons (their type: moto and inter). As a result, the number of pulses reaching alpha motoneurons increases. This is a response to muscle strain.
The decrease in TB is a consequence of the combined defects of the pyramidal channels inside the brain (both spinal and brain). Most often, muscle spasticity develops due to the fact that the cortico-reticulo-spinal tract is damaged.
If the brain is affected, TV also weakens, but most of all it affects gamma-motor neurons. They drive the movement of anti-gravity muscles. As a result, a characteristic post-stroke spastic hemiparesis is manifested:
- Shoulder and thigh.
- Elbow and wrist joints bend
- The knee extends.
When spinal spasticity develops, TB decreases for interneurons located in this area. Because of what, excitations along nerve fibers spread to other levels, and pathological symptoms appear.
Outwardly, most often this manifests itself in convulsions and uncontrolled movements.
Expressed differently, when muscle spasticity occurs during cerebral palsy, energy is accumulated in them, communication with the brain is broken or missing. They misunderstand his commands and contract chaotically at any time. So the accumulated energy is spent.
If the central paresis cannot be cured for a long time, for example, for more than six months, then the segmental apparatus of the spinal cord changes structurally. This is manifested in a violation of the connections between nerve fibers and the work of paretic muscles, tendons and joints. Because of this, there is an increase in motor disorders and resistance that forms in the muscle when it is stretched. Doctors must take this into account when analyzing muscle tone in paretic or paralyzed arms and legs.
Spasticity level
For its analysis, different scales are used. The most common product is Ashworth. The scoring system for muscle tone here is:
- 1 - it is increased slightly, the condition quickly eases;
- 1a - slight excess, muscles strain less than 50% of the total number of passive movements;
- 2 - moderate development during 100% of the range of movements (passive actions are realized easily);
- 3 - significant growth (movements are problematic);
- 4 - the paretic part of the limb does not unbend or bend completely.
Therapy measures
The main task in the treatment of muscle spasticity is the improvement of the potential and functioning of the affected limbs.
Doctors decide how increased tone affects the patient’s functional abilities. In people suffering from central paresis, the limbs are less active when compared with patients who have 1-2 points on the indicated scale.
Some patients with high spasticity of the leg muscles walk and stand easier. And with a decrease in its degree, they move much worse.
Before starting therapy, doctors identify a treatment plan in a particular case (improving movement, reducing negative spasms, etc.) and coordinate it with patients or their relatives.
The specifics of treatment are largely determined by the period from the moment of illness and the level of paresis. The shorter the time from the onset of the ailment, the greater the chance of effective therapy.
To achieve a positive result, the following methods are used:
- Physiotherapeutic.
- Pharmacological.
- Surgical.
Physiotherapy
Her main task is to train movements in problematic limbs and avoid complications.
During the course of this therapy, patients are trained to sit, stand and walk. Additional funds are used for this.
Also, patients are bandaged with limbs, orthopedic equipment are used, and spastic muscles are exposed to heat radiation.
To effectively remove muscle spasticity, specialists arrange electrical stimulation of problem areas.
As a rule, these are extensors of the fingers or the anterior tibial muscle.
Pharmacology
Here, the greatest effect is exerted by central muscle relaxants. Their patients are taken orally. These drugs have the following advantages:
- reduce muscle tone;
- improve motor potential;
- relieve painful cramps;
- enhance the effect of therapeutic exercises;
- facilitate the care of paralyzed patients;
- prevent the appearance of contractures.
If muscle spasticity is characterized by a mild level, muscle relaxants have a quick positive effect. With a complicated disease, they are used in large doses. This is fraught with negative side effects.
Treatment with these drugs begins with a minimum dosage. It is gradually developing to achieve the necessary task.
Combinations of drugs against this disease are not allowed.
In Russia, these pills for muscle spasticity are also most often used:
- Sirdalud. Suppresses polysynaptic reflexes in the spinal cord, has a moderate central analgesic effect. It is especially effective in the treatment of spasticity of cerebral and spinal muscles. The minimum daily dose is 3 times 6 mg, the average is 12-24 mg, and the maximum is 36 mg. Side effects: drowsiness, insignificant drop in blood pressure.
- "Baclofen." It is mainly used to treat spinal spasticity. It effectively suppresses the generation of tonic amino acids and has a central analgesic effect. Minimum daily dosage: 15 mg x 3. Gradually, it daily increases by 5 mg. The maximum is 60-75 mg. Side effects: nausea, constipation, diarrhea, hypertension. Therefore, the drug should be carefully used by the elderly.
- Tolperizon. Powerfully suppresses spinal reflex activity, has a mild vasodilator and central analgesic effect. Reduces cramping. It is used in the fight against spasticity of two types: spinal and cerebral. The initial dose per day is 150 mg. It develops systematically to 300-450 mg. Side effects: drowsiness, muscle weakness, arterial hypotension.
Class A Botulinum Toxin Injection
This is an additional measure when there is increased muscle activity without contracture, but with severe pain and cramping. The drug reduces the range of motion and normalizes motor function. It is administered intramuscularly.
The clinical effect after the injection appears in 2-4 days and lasts 2-6 months. Then, if necessary, the injection is repeated.
The duration of the effect is due to the dosage of the drug itself and the complexity of the disease.
As a result of its use, the muscle contracts normally. This is due to the fact. That injected toxin breaks down proteins. Gradually, they recover, and nerve endings grow, leading to the generation of new synapses.
Side effects of the injection: itching and pain in its place, significant muscle weakness.
Surgical intervention
To reduce muscle spasticity, it can occur at any of these levels:
- brain;
- dorsal;
- peripheral nerves;
- the muscles.
The brain is operated like this: electrocoagulation of a pale ball or cerebellum is turned on. A stimulator is implanted on the surface of the latter.
These operations are quite complex and dangerous. Therefore, they are used extremely rarely.
Spinal cord treatment can be arranged as follows: a cone is cut along a longitudinal line. This breaks the reflex arc separating the posterior and anterior horn of this brain.
The operation is carried out only in the most extreme cases and with spasticity of the leg muscles. It requires great skill of the surgeon and implies a high risk of serious complications.
To eliminate spasticity, peripheral nerves can be dissected. Because of this, severe pain and dysesthesia develop. After it, orthopedic procedures are performed. For this reason, it is practically not used today.
And the most common surgical intervention is as follows: the tendon of the muscle is lengthened, or it moves. Thus, the activity of its intrafusal fibers decreases and, as a result, spasticity.
The effect of this method is difficult to predict. In complex cases, a series of operations is performed. If contracture develops, this method remains the only measure of therapy.
The situation after a stroke or head injury
Here, physiotherapy exercises come to the fore. She settles down from the first days of illness and trains the lost movements. The patient begins to stand and walk on his own.
Of the medicines, Sirdalud is most often prescribed. The doctor correctly determines and develops its dosage in order to prevent a sedative effect.
With muscle spasticity during a stroke, motor functions can seriously deteriorate. In this case, botulinum toxin is administered. Optimal results are achieved if his injections are made in the early period (less than a year) of the disease and a modest level of paresis.
Multiple sclerosis
In patients with this disease, spasticity of the muscles is often found. The reason for this is damage to the spinal cord.
The greater negative impact is on the lower limbs. And about a quarter of patients experience serious problems with motor functions.
To improve the condition, Sirdulud or Baclofen is used. Exhausting muscle cramps are relieved with diazepam. Therapy begins with minimal dosages. They gradually increase
Surgical measures with a similar diagnosis are used for two purposes:
- reduce spasticity;
- improve the functionality of the pelvic organs.
If the patient suffers from local spasticity in the legs, botulinum toxin is injected into the muscles of the thigh and lower leg.