Neuroimaging Assessment of Spasticity Developed after Acquired Brain Injuries and Multiple Sclerosis

Abstract

This study evaluated whether different imaging techniques correlate with specific variables routinely used to grade the types and complexities of patient conditions in neurorehabilitation services and their clinical outcomes, and if there are radiological patterns, topography or distribution of the lesions correlated to spasticity. The cohort studied included 75 patients, 38 patients with multiple sclerosis (MS) and 37 patients with acquired brain injuries (ABI) referred to the neurorehabilitation department from April 2009 to March 2010. Data included age, gender, diagnoses, complications, spasticity, length of stay, Rehabilitation Complexity Scale (RCS) and Northwick Park Dependency (NPDS) scores on admission and discharge. Forward stepwise multiple regressions were performed considering Spasticity as dependent and considering NPDS, RCS on admission and discharge, age, gender and length of stay as independent variables. Standardized intra-axial lesions in those with spasticity were fused with standardized axial DTIs from normal controls obtained under 3 T and 1.5 T MRI scanners. Spasticity was present in 36 patients. Regression was found between spasticity and all the other variables with r = 0.42, r(2) = 0.17, adjr(2) = 0.12(r), F(4,66) = 3.53, p < 0.01. Residuals were acceptable. If the same is calculated excluding MS patients the results are higher with: r = 0.59, r(2) = 0.35, adjr(2) = 0.30, F(2,27) = 7.1885, p < 0.003. In MS subjects, spasticity appeared if lesions affected pyramidal tracts, callosal radiations extensively or brainstem. Those with ABI did develop spasticity if the lesion involved the internal capsules, pericommissural areas, optochiasmatic cistern or brainstem. Findings suggest that NPDSa and discharge and RCSd are higher in those developing spasticity. No obvious correlation between spasticity and RCSa was found. Subjects with MS are more likely to develop spasticity especially if the lesions are numerous and affect the corticospinal tracts, callosal radiations extensively or brainstem. In patients with ABI lesions affecting pyramidal tracts, pericommissural areas and optochiasmatic cisterns seem more likely to develop spasticity.

Fractional Anisotropy Brain Changes in Spasticity after Peripheral Injections of Botulin

“…The degree of spasticity improved in all subjects after the injection of botulin toxin. Their mean spasticity score in the Disability Assessment Scale improved from 2.5 (2)(3) previously to the injection to 1 (0-2) post-injection.…”

“…It is estimated that around 75% of patients with severe traumatic brain injury, 20% of stroke survivors and 60% of subjects with moderate to severe Multiple Sclerosis require specific spasticity treatment [2].…”

Clinical insights on the spasticity-plus syndrome in multiple sclerosis

“…Multiple MS studies conducted neuroimaging to address the brain network connectivity of cognitive functions, pain, and fatigue, but few evaluated spasticity. A retrospective study reported three main regions with DIT for MS participants who developed spasticity: the genu or the posterior limb in the internal capsule, the rostral brainstem, and the callosal radiations cross interleaving with corticospinal tracts (16). Another small-sized study evaluated the impact of intermittent theta brain stimulation on MS participants with spasticity and showed the relevance of resting-state fMRI in highlighting the treatment effect on spasticity with a functional reorganization of the primary motor cortices, favoring connections of the contralateral primary motor cortex to other cerebral regions (17).…”