Pharmacologic Management of Spasticity Following Stroke

Extract

Spasticity is a pervasive and debilitating condition that frequently occurs following upper motor neuron (UMN) lesions. Although the exact incidence of spasticity is unknown, it is likely that it affects more than half a million people in the United States alone, and more than 12 million people worldwide.¹ Following stroke, approximately 65% of individuals develop spasticity.²

The definition of spasticity is variable among health care professionals. To some, spasticity simply refers to a velocity-dependent resistance to movement. For others, spasticity is part of a central motor neuron syndrome that includes hyperactive deep tendon reflexes, increased resistance to passive movement, flexed posturing of the upper extremity and extension of the lower extremity, excessive contraction of antagonist muscles, and synergistic movement patterns.³ In 1980, Lance published this frequently cited definition: “Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex, as one component of the upper motoneuron syndrome.”^4(p485)