Treatment of Spasticity

1. What measures can be taken to prevent spasticity?
2. What physical modalities and therapies are used to prevent spasticity?
3. How does baclofen work? What are the main side effects? What occurs if it is stopped suddenly?
4. How does diazepam work? What are the main side effects? What sort of patients should it be used with?
5. How does dantrolene work? What are the main side effects?
6. What are two central alpha-2 agonists used to treat spasticity? What are their main side effects?

Answers:
1. Daily stretching, avoidance of noxious stimuli (infection, pain, DVT, HO, pressure ulcers, urinary retention).
2. Heat, cold, stretching, splinting, serial casting, proper positioning, functional e-stim, vibration, relaxation techniques, motor re-education, biofeedback.
3. Baclofen is a GABA-B analog that binds to receptors in spinal cord, inhibiting the calcium influx. Side effect include sedation, weakness, GI symptoms, tremor, insomnia, and confusion. Withdrawal can cause seizures and hallucinations.
4. Diazepam acts on GABA-A receptors, facilitating post-synaptic effects of GABA, inhibiting muscle contraction. Side effects include sedation, so it is mainly useful in SCI patients rather than TBI.
5. Dantrolene acts peripherally on the striated muscle, blocking Ca release from SR, inhibiting muscle contraction. Side effects include hepatotoxicity (1%), sedation, weakness, fatigue, paresthesias, diarrhea, N/V.
6. Clonidine and tizanidine. Both cause hypotension, sedation, dry mouth. LFT monitoring is suggested with tizanidine.