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When Muscles Won't Relax: Understanding Post-Stroke Spasticity
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Treating Post-Stroke Spasticity: What Your Doctor Needs to Know
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Rehabilitation After Stroke: What Can Be Done?
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Stroke Recovery: The Basics of Physical Rehabilitation
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Life After Stroke: Personal Perspectives
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TIA: A Warning Not to be Ignored
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Are You at Risk for a Stroke?
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What are the Warning Signs of a Stroke?
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Helping a Loved One Recover From a Stroke
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Caregiver Involvement in Post-Stroke Care
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Webcast Transcript
MAYER, MD: And so they have been using the same medication approved for other conditions in conditions for which the drug hasn't technically been approved, and this is called an off-label use. This is something which is commonly done and the good results clinically are validating.
ANNOUNCER: But Botox won't work for everyone and some practitioners think it's best suited for patients with spasticity in a few isolated areas, or what's called focal spasticity.
NATHANIEL H. MAYER, MD: Some patients who have damage in the brain will have muscle overactivity in only a small number of muscles, so a foot might turn in, but the rest of the leg is really not problematic, or a hand might be bent at the wrist but the elbow is uninvolved. We often call that focal to indicate that's a more circumscribed or localized type of problem. And for this purpose, an injectable medicine that gets to the muscles is really quite effective and certainly desirable.
ANNOUNCER: But in patients with generalized spasticity that affects whole regions of the body, like the legs or torso, Botox injections may be impractical. In these cases, the solution may be intrathecal Baclofen which works by using an old drug in a new way.
ALBERTO ESQUENAZI, MD: And what it entails is to take one of the oral drugs, baclofen, and deliver that directly into the spinal cord. And it requires that a surgeon or an anesthesiologist implant a small tube into the spinal cord and a pump under the abdomen skin. And then the drug gets delivered into the pump, meaning you inject the drug into the pump, and then the pump will pump it into the spinal cord in a continuous or intermittent fashion. And in this way the drug gets delivered to the site where it will have the most effect with the least amount of side effects.
ANNOUNCER: By delivering tiny amounts of baclofen straight to the spinal fluid, the device maximizes the positive effects of the drug while protecting the rest of the body from exposure.
CINDY IVANHOE, MD: Patients don't have the same sedation and lethargy and weakness that you can see when you take the medication orally. Additionally, the effects of the medication given intrathecally are much greater than the effects of the medication given orally.
ANNOUNCER: So who is a good candidate for ITB? Though it's generally recommended for the most severe cases, experts have varying opinions.
ALBERTO ESQUENAZI, MD: Intrathecal baclofen is best used for those patients that have very severe spasticity, particularly patients that have had a spinal cord injury or have a disease called multiple sclerosis. Those tend to be the better candidates for that type of treatment.
CINDY IVANHOE, MD: It really is more a question of what your patient's goals are and what you're trying to accomplish with your intervention. I have patients who had intrathecal baclofen pumps who are in vegetative state, who have no true interaction with their environment. I also have patients who have come to me who were ambulating at the time that I prescribed the baclofen pump, but they wanted to be able to ambulate better, or walk better, or were concerned about degenerative changes in their joints as they aged, and those patients are often candidates for ITB therapy as well.
ANNOUNCER: Experts hope that the successes of Botox and ITB will lead to even more effective spasticity treatments in the future. But for the time being, patients with any type of spasticity should know that there are solutions that can help.
ALBERTO ESQUENAZI, MD: There are solutions. There are ways to improve their symptoms and to allow them to have a more successful and more enjoyable life.
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