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 when the muscles contract too intensely when they are rapidly stretched. Patients often experience decreased muscle strength, loss of voluntary control of movement, and even 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:
- Injury to the brain (both spinal and brain).
- Strokes.
- Infectious diseases in which inflammation affects the brain, such as meningitis.
- Hypoxia is a pathology that occurs due to oxygen deficiency.
- Amyotrophic lateral sclerosis.
Categories of violations
There are only three of them in the classification of muscle spasticity:
Flexor. Flexor muscles are characterized by increased tone when bending and raising the arms or legs injoints
Extenous. A similar picture to item 1, only the process occurs in the extensor muscles
Adductor. The tone develops when the knees close and the legs cross in the shins
Central paresis
With this disease, spasticity develops due to a reduction in inhibitory effects (TV) on spinal neurons (their type: moto and inter). As a result, the number of impulses reaching the alpha motor neurons increases. This is a response to a muscle stretch.
Decrease in TV is a consequence of cumulative defects in the pyramidal canals 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, TVs also weaken, but this is most reflected in gamma motor neurons. They set the movement of the anti-gravity muscles. The result is a characteristic post-stroke spastic hemiparesis:
- Shoulder and hip are shown.
- Bending elbow and wrist joints
- Knee extension.
When spinal spasticity develops, TB decreases on interneurons located in this area. Because of what, excitations spread along the nerve fibers to other levels, and pathological symptoms appear.
Outwardly, most often this manifests itself in convulsions and uncontrolled movements.
In other words, when muscles spasticity occurs in cerebral palsy, energy is accumulated in them, the connection with the brain is broken or absent. They misunderstand himcommands and shrink chaotically at any time. This is how the accumulated energy is spent.
If central paresis cannot be cured for a long time, for example, more than six months, then the segmental apparatus of the spinal cord changes structurally. This is manifested in the disruption of connections between nerve fibers and the work of paretic muscles, tendons and joints. Because of this, there is an increase in movement disorders and resistance formed 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
Different scales are used for its analysis. The most common is the Ashworth product. The scoring system for muscle tone here is:
- 1 - it is slightly elevated, the condition quickly improves;
- 1a - slight excess, muscles tense in less than 50% of the total number of passive movements;
- 2 – moderate development during 100% range of motion (passive actions are implemented easily);
- 3 – significant growth (moves are problematic);
- 4 - the paretic part of the limb does not extend or flexes completely.
Therapy measures
The main task in the treatment of muscle spasticity is to improve the potential and work of the affected limbs.
Doctors decide how increased tone affects the functional abilities of the patient. 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 highthe level of 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 (improvement of movement, reduction of 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 less time since the onset of the disease, the greater the chance of effective therapy.
To achieve a positive result, the following methods are used:
- Physiotherapy.
- Pharmacological.
- Surgical.
Physiotherapy
Her main task is to train movements in problematic limbs and prevent complications.
During the course of this therapy, patients are taught to sit, stand and walk. Additional funds are used for this.
Also, patients are bandaged, orthopedic equipment is used, and spastic muscles are exposed to thermal radiation.
To effectively relieve muscle spasticity, specialists arrange electrical stimulation of problem areas.
Usually these are the extensors of the fingers or the anterior tibialis.
Pharmacology
Here, central muscle relaxants have the greatest effect. Their patients take orally. These drugs have the followingmerit:
- decrease muscle tone;
- improve motor potential;
- relieve painful spasms;
- enhance the effect of therapeutic exercises;
- facilitate the care of paralyzed patients;
- prevent contractures.
If muscle spasticity is characterized by a mild level, muscle relaxants have a quick positive effect. In complicated diseases, they are used in large doses. This is fraught with negative side effects.
Treatment with these drugs starts with a minimum dosage. It gradually develops to achieve the required task.
Combinations of remedies for this disease are not allowed.
In Russia, such pills for muscle spasticity are also most often used:
- "Sirdalud". Suppresses polysynaptic reflexes in the spinal cord, has a moderate central analgesic effect. Particularly effective in the treatment of spasticity of the muscles of the cerebral and spinal type. The minimum daily dose is 3 times 6 mg, the average is 12-24 mg, the maximum is 36 mg. Side effects: drowsiness, insignificant drop in blood pressure.
- "Baclofen". 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 increases daily by 5 mg. Maximum - 60-75 mg. Side effects: nausea, constipation, diarrhea, hypertension. Therefore, the drug should be used with caution in the elderly.
- "Tolperisone". Powerfully suppresses spinal reflex activity, has a mild vasodilating and central analgesic effect. Reduces spasms. 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 up to 300-450 mg. Side effects: drowsiness, muscle weakness, hypotension.
Botulinum Toxin Grade A Injection
This is an additional measure when there is increased muscle activity without contracture, but with severe pain and spasms. The drug reduces the range of motion and normalizes motor function. Administered intramuscularly.
Clinical action after the injection appears after 2-4 days and lasts 2-6 months. Then, if necessary, the injection is repeated.
The duration of the effect is determined by the dosage of the drug itself and the complexity of the disease.
As a result of its application, the muscles contract normally. This is explained by. That the injected toxin destroys proteins. Gradually, they are restored, 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.
Surgery
To reduce muscle spasticity, it can occur at any of these levels:
- brain;
- dorsal;
- peripheral nerves;
- muscles.
The brain is operated on as follows: electrocoagulation of the globus pallidus or cerebellum is switched on. A stimulator is implanted on the surface of the latter.
These operations are rather complicated and dangerous. Therefore, they are used extremely rarely.
Treatment of the spinal cord can be arranged as follows: a cone is dissected along the longitudinal line. This breaks the reflex arc that separates the posterior and anterior horns of this brain.
The operation is carried out only in the most extreme cases and with spasticity of the muscles of the legs. It requires great skill of the surgeon and carries a high risk of serious complications.
Peripheral nerves can be cut to eliminate spasticity. Because of this operation, severe pain and dysesthesia develop. It is followed by orthopedic procedures. For this reason, it is practically not used today.
And the most common surgical intervention is performed as follows: the tendon of the muscle lengthens, or it moves. This reduces the activity of its intrafusal fibers and, as a result, spasticity.
The effect of this method is difficult to predict. In difficult cases, a series of operations is performed. If contracture develops, this method remains the only measure of therapy.
Situation after a stroke or head injury
Here physical therapy comes to the fore. She settles down from the first days of illness and trains the lost movements. The patient begins to stand and walk independently.
Of the drugs most often prescribed "Sirdalud". The doctor correctly determines and develops its dosage in order to prevent a sedative effect.
When spastic muscles during a stroke, motor functions can seriously deteriorate. In this case, botulinum toxin is injected. Optimal results are achieved if its injections are given early (less than a year) of the disease and with a modest level of paresis.
Multiple Sclerosis
In patients with this disease, muscle spasticity is often found. The reason for this is damage to the spinal cord.
The lower limbs are more affected. And about a quarter of patients experience serious problems with motor functions.
To improve the condition, use Sirdulud or Baclofen. Debilitating muscle spasms are relieved with diazepam. Therapy begins with minimal dosages. They are gradually increasing
Surgical measures for such a 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.
