Don’t confuse focal spasticity with general spasticity: the two are very different and require different treatment. Follow these tips to help you better deal with focal spasticity.
Spasticity is a condition that is commonly seen in patients who have suffered a neurological event. It is the uncontrolled contraction of muscle groups, and often occurs in patients living with spinal cord injury, traumatic brain injury, cerebral palsy, stroke and other neurological disorders affecting the central nervous system.
Spasticity can not only inhibit function and thus lead to greater loss of independence, but can also cause local problems such as pain, contractures and difficulty with hygiene. Ideally it should be treated and managed adequately by a multidisciplinary team before complications set in.
Spasticity can be generalised – that is, affecting most or all muscle groups (usually seen in spinal cord injury) – or focal and limited to specific muscle groups such as a single limb. Generalised spasticity is managed with oral medications (muscle relaxants) or infusion pumps.
Focal spasticity, which is commonly seen in patients who have suffered a traumatic brain injury or a stroke, should not be treated with oral medications, which unselectively cause muscle relaxation. Instead, specific treatment of focal spasticity could include:
- Physical management, which includes good nursing care, physiotherapy and occupational therapy through the use of techniques to improve postural management, exercise, stretching and strengthening of limbs, splinting and pain relief. (These interventions are the basis of spasticity management, and are used as a first line of defence for not only focal but also generalised spasticity.)
- Interventions using transcutaneous electrical stimulation, acupuncture and acupressure.
- If these are insufficient, a further possible intervention is the use of injectable drugs. These would include Phenol nerve blocks and the use of Botulinum Toxin (Botox) injections. Botox is better known as the wonder drug used to restore a youthful look, but both Phenol and Botox are useful to add to the physical management of patients with focal spasticity.
Phenol injections seem to be used less often today, as the potential for complications is high, the drug is potentially harmful with lasting neurological loss and the injections are not simple to give (and are potentially painful). Botox, on the other hand, although much more expensive, is easier to administer, the effects are not permanent (lasting up to four months) and it has been used very successfully to manage focal spasticity.
Many medical funders are now beginning to appreciate the value of Botox in the management of focal spasticity; although expensive, in the long run it can save money by preventing complications and improving quality of life. Not only can Botox be used in the management of focal limb spasticity, but it is now also widely used to treat overactive bladders.
Your therapist would normally recommend you visit your rehab doctor if Botox is being considered. Don’t forget to ask your doctor to save a drop or two to inject those pesky forehead wrinkles!
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: firstname.lastname@example.org