Hypertonia

Abstract

Hypertonia is the abnormal increase in muscle tone as a result of upper motor neuron lesions. There are three following clinical types: spasticity, dystonia, and rigidity. Management of hypertonia is individualized and should be directed by the patient and/or family׳s goals of care as well as the underlying cause of the hypertonia. Treatment options include stretching, strengthening, positioning, oral medications, botulinum toxin injections, phenol injections, as well as surgical procedures. Without effective management, hypertonia can result in muscle imbalance, abnormal movement patterns, pain, joint contracture, joint deformity, and ultimately negatively impact a patient׳s function. This discussion serves as an overview of hypertonia, focusing on spasticity and dystonia, in the pediatric population by examining the causes and epidemiology, elucidating its symptoms, discussing available treatment and management options, and clarifying why this all matters.

Heart rate variability alterations in infants with spontaneous hypertonia

“…Also, recruited infants needs to show no history of hospital re-admissions after delivery. Hypertonia was diagnosed by a physiatrist when five or more of the following criteria where met: 3,15 (i) increased axial tone, (ii) increased upper limb tone, (iii) increased lower limb tone, (iv) increased osteotendinous reflex, (v) clonus, (vi) delayed psychomotor development, (vii) persistent plantar and/or palmar reflex, and (viii) signs of Babinski. 3,15 The number/percent of subjects respect to each of the diagnostic criteria are shown in Table 1.…”

“…Hypertonia was diagnosed by a physiatrist when five or more of the following criteria where met: 3,15 (i) increased axial tone, (ii) increased upper limb tone, (iii) increased lower limb tone, (iv) increased osteotendinous reflex, (v) clonus, (vi) delayed psychomotor development, (vii) persistent plantar and/or palmar reflex, and (viii) signs of Babinski. 3,15 The number/percent of subjects respect to each of the diagnostic criteria are shown in Table 1. Exclusion criteria were the following: (i) infants over 2 years old, (ii) under concomitant anticonvulsant drug therapy or any another drug that may influence the autonomic nervous system (i.e., Baclofen, valproic acid), and (iii) infants with metabolic disease, heart disease, or acute infection.…”

“…1 Clinically, hypertonia is characterized by resistance to externally imposed movement that increases with the speed of stretch. [1][2][3] Hypertonia is commonly observed in several pathologies, including hydrocephalus, stroke, multiple sclerosis, and traumatic brain or spinal injury. 3 Although cerebral palsy is the most common cause of hypertonia in children, 3 a significant number of infants display spontaneous hypertonia in the absence of pyramidal neuron lesions.…”

“…[1][2][3] Hypertonia is commonly observed in several pathologies, including hydrocephalus, stroke, multiple sclerosis, and traumatic brain or spinal injury. 3 Although cerebral palsy is the most common cause of hypertonia in children, 3 a significant number of infants display spontaneous hypertonia in the absence of pyramidal neuron lesions. 4 The precise mechanisms underpinning development of spontaneous hypertonia in newborns is incompletely understood, however it has been proposed that this condition is related to poor maternal health (i.e., drug abuse, metabolic disorders, trauma) during pregnancy.…”

The Severity of Neurological Dysfunction in Preschool Children, Secondary to Damage Generated During the Perinatal Period, is Associated With a Pro-Inflammatory Pattern of Serum Molecules

“…This could reflect an inadequate functioning of the upper motor neuron and its interaction with the cerebellum. The latter because of its influence on the medial descending system involved in the regulation of muscle tone, posture, spinal reflexes, balance, and the execution of fine movements ( 36 – 38 ). Asymmetry in childhood is a clinical picture involving posture, function, and movements.…”