STROKE & SPASTICITY

[Wayne-Crouse]

    
      Re: STROKE & SPASTICITY
    


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Posted by CCF Neuro MD on May 13, 1997 at 21:05:16:

In Reply to: STROKE & SPASTICITY posted by Wayne Crouse on May 06, 1997 at 03:18:03:

: Help please! I awoke one morning with numbness on the left side and was diagnosed as having suffered a "mild" stroke. I am a male, 50, with Type II diabetes well-controlled by diet. I am having a terrible time with knotted muscles on my left side. I believe this is known as spasticity. This condition saps my strength and is very persistent. Is this common in stroke? Are there medicines or treatments that are helpful. My physician admits he is not up on the latest medications.
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Your question is an excellent one.  Spasticity, is a common in patients who have had a neurologic insult such as a stroke, multiple sclerosis or cerebral palsy to name a few.  Spasticity is the resistance of a muscle to passive stretch.  It is thought to be due to loss of inhibitory influences from the nervous system.  Patients may complain of stiffness, spasms and pain.  These spasms may be stimulus related.  Spasticity may severely affect one's ability to function.  It may make one feel that they are weaker due to the loss of use of an arm or leg.  Luckily there are a number of medications that can adequately treat spasticity. They include baclofen (10 mg/d-2x/d up to 80 mg/d), which is considered first line treatment.  There is also a new agent on the market called tizanidine which is well tolerated and effective.  Benzodiazepines, such as valium (1-2 mg 2x-3x/d and increased to 20-30 mg/d) provide benefit in a number of patients, and may be used in conjunction with the other 2 drugs.  Drug dependence may develop with use of valium , therefore it should be monitored carefully ( but still a good option).  Dantrolene (25 mg/d up to 100 mg 4x/d) may be used when the other 3 choices fail.  Some neurologist may use botulinum toxin injections to reduce the amount that a muscle may contract.  It is important also that you maintain a good range of motion exercise program on a daily basis to prevent muscle contractures, thus increasing your function.  
I would suggest you may want to seek an opionion of another physician if your local physician feels uncomfortable in treating spasticity.  There are a number of neurologists that specialize in cerebrovascular disease.  Another good option is to see a rehabilitation physician/physiatrist who can give you additional advice in regaining function and advise on other activities of daily living that you may be having difficulty in after your stroke.  If you live near Cleveland, we have a number of physicians who could assist in your care.  Simple call 1-800-233-2273 ext. 45559 for an appointment.  Here is information from a national stroke association that may be a help in finding you a physician if you are not in our area.  However, most major academic hospitals should have what you need.  Good luck
National Stroke Association
National. 7 chapters. Founded 1984. Dedicated to reducing the incidence and severity of stroke
through prevention, medical treatment, rehabilitation, family support and research. Research
grants on prevention and treatment. Newsletter, professional publication, information and
referrals. Guidance for starting stroke clubs and groups. Write: National Stroke Association, 96
Inverness Dr. East, Suite E, Englewood, CO 80111-5112. Call [phone] or
800-STROKES; FAX: [phone].