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When Muscles Won't Relax: Understanding Post-Stroke Spasticity
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State-of-the-Art Treatments for Post-Stroke Spasticity
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 play videoTime: 7:15 minutes |
Participants
, Alberto Esquenazi MD, Mabel Jong , Nathaniel H. Mayer MD
Summary
After a stroke or other brain injury, certain muscles may start to contract involuntarily, often causing pain or restricting movement. This is called spasticity, and it can be treated, but it's important for patients to communicate their problem to their doctor in order to receive effective care.
Webcast Transcript
MABEL JONG: Hello and welcome to our webcast. I'm Mabel Jong. Spasticity is a complication after stroke or other brain injury where the muscles typically in the arm or leg contract involuntarily, often causing pain and restricting movement. It's a significant issue but one that is often overlooked because of the many other changes in a person's body after a stroke.
Here to talk about the treatment for spasticity and why it's so important to talk to your doctor about it are Dr. Nathaniel Mayer and Dr. Alberto Esquenazi, both of MossRehab at the Albert Einstein Medical Center in Philadelphia. Gentlemen, thanks so much for being with us.
Well, first, Dr. Esquenazi, could you describe for me what spasticity is and why it's significant for stroke patients?
ALBERTO ESQUENAZI, MD: Many patients after they have a stroke develop damage to their brain will develop this term spasticity, which is an increase in the muscle tightness, the muscle stiffness and the muscle activity that occurs when they have a lesion to their brain. And what it does is it basically prevents the patient from being able to function in a normal manner. Their arm or their leg might not be able to move in a normal fluid manner and so would require that they either be aided to dress or to walk or that they may have discomfort, pain or difficulty even washing their hands or feet. And being able to reduce that spasticity will make a big difference in the way they function.
MABEL JONG: Dr. Esquenazi, what are some of the latest treatment options?
ALBERTO ESQUENAZI, MD: There are a variety of new treatment options that traditionally spasticity has been treated with pills. And one of the major problems of using oral agents is that they do have side effects. And there are two new modalities of treatment. One is an injectable treatment in which you use Botox or botulinum toxin that is directly injected into a particular muscle and has really no side effects other than affecting the muscle that you want to relieve spasticity from.
The second new intervention is intrathecal Baclofen. So you take the same medication that you would give by mouth, but this time you insert a very thin catheter, a very thin tube into the spinal cord and through a pump you can deliver medication very precisely just to the spinal cord and reduce the tendency for side effects.
MABEL JONG: How should one go about talking to their doctor about this condition?
NATHANIEL H. MAYER, MD: I think that when you go to the physician you have to emphasize what's really bothersome. That is, what is really problematic. You can't take a global view and say, "I can't move and I want to be able to move" because that may not be something that would be entirely possible. But if you tell the physician that your fingernails are digging into the palm, that you can't open your hand to wash, that you can't open your elbow to wash or to put on a sleeve or a coat, then those are very specific complaints that the physician can then say, "Well, if I'm not sure about this, I might be able to refer you to a specialist who does deal with the problem of a foot turning in, or fingernails digging into the palm or that sort of thing."
MABEL JONG: Now, Dr. Mayer, what are the barriers that exist for patients trying to receive the right treatment for them?
NATHANIEL H. MAYER, MD: Very often when a patient tries to find out what can benefit them, they're told that "Well, you've had a stroke and we can't reverse the problem in the brain so there really isn't very much more you can do about it except to just live with the problem." And actually a lot can be done if you understand what the stroke has done to muscles.
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