Pathophysiology of spasticity in stroke
Abstract
Spasticity is defined clinically by increased muscle tone and tendon jerk hyperreflexia in patients who are at rest. However, the excitability of spinal circuits changes during movement, and this definition provides no insight into the extent to which spasticity and associated motor disturbances cause disability. Only a few spinal circuits have been shown to underlie the abnormalities of patients at rest. Movement can be restrained by pathologically enhanced muscle tone, and there is defective control of the feedback to active motoneurons through virtually all spinal reflex pathways. Spasticity does not necessarily require treatment: in fact, some patients rely on the increased muscle tone to help support otherwise weak muscle contractions for stance and locomotion. In addition, much of the increase in muscle tone arises from changes in muscle and motor units, independent of reflex mechanisms. Managing a patient with impairment after a stroke requires therapy tailored to that particular patient because the mechanisms contributing to the disability experienced by one patient may differ from those affecting another.
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Information & Authors
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Published In
Neurology®
Volume 80 • Number 3_supplement_2 • January 15, 2013
Pages: S20-S26
Copyright
© 2013 American Academy of Neurology.
Publication History
Published online: January 14, 2013
Published in print: January 15, 2013
Authors
Disclosure
Dr. Burke serves as editor-in-chief for Clinical Neurophysiology and as an editorial board member of The Journal of Clinical Neuroscience. He serves and has served in the past as chief investigator for research funded by NHMRC Project Grants, and has also received funding from the Sydney Foundation for Medical Research, the Philip Bushell Foundation, and the Brain Foundation. Dr. Wissel served on scientific advisory boards for and received speaker honoraria, funding for travel, and research support from Allergan, Inc., Merz Pharmaceuticals, Medtronic, and Ipsen Pharma. Dr. Donnan served on scientific advisory boards for and received speaker honoraria and funding for travel from Allergan, Boehringer Ingelheim, Bayer, and Sanofi. He also served as a journal editor/associate editor/editorial board member of Lancet Neurology, Stroke, Cerebrovascular Diseases, and the International Journal of Stroke.
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