Spasticity: from pathophysiology to treatment

Iskra, D A; Коваленко, А. П.; Koshkarev, M A; Dyskin, D E

doi:10.17116/jnevro2018118101108

Cited by 10 publications

(10 citation statements)

References 56 publications

(50 reference statements)

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“…This provision has a pathophysiological justification. One version of the pathogenesis of spasticity is the activation of muscle contraction in response to afferentation insufficiency [7]. Obtaining information about the degree of proprioception impairment allows us to predict the subsequent development of spasticity, suggesting the effectiveness and assessing the dynamics of rehabilitation.…”

Section: Scales For Assessing Spasticity and Disorders Of Activity Anmentioning

confidence: 99%

“…Alexander Kovalenko 1,2 *, Viktor Misikov 3 , Konstantin Sinelnikov 4 , Valeriy Shamigulov 5 , Dmitrii Iskra 1,6 , Svetlana E. Khatkova 7 and Denis V.…”

Section: Author Detailsmentioning

confidence: 99%

“…In 1-3 weeks after UMNL, the connections of the cerebral cortex with the structures of the extrapyramidal system (EPS) begin to recover. Recovery time varies depending on the degree of damage: from 2 weeks to 3 months [7].…”

Section: Introductionmentioning

confidence: 99%

“…However, the latter does not receive a sufficiently powerful efferentation due to the continuing defective functioning of the pyramid path. The result of this is the lack of inclusion of a sufficient number of inhibitory cells (Renshaw), which could inhibit α-small MN and lower muscle tone [7,8].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Spasticity: Diagnosis and Treatment

Коваленко¹,

Мисиков²,

Sinelnikov³

et al. 2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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This chapter presents the technology of spasticity treatment-from diagnosis and treatment to quality control of treatment and rehabilitation. The diagnosis is based on methods of manual testing and differential diagnosis of spastic muscles, methods of quantitative assessment of spasticity on the basis of the Tardieu scale. The methodical development of the Tardieu scale with variants of its full and reduced use is presented. The basic patterns of spasticity of the upper and lower limbs are given. Schemes of management of patients with spasticity with indication of control points for application of methods of an assessment that shows efficiency of treatment and rehabilitation are presented. The methodology of spasticity treatment using botulinum neurotoxin (BoNT), including ultrasonic navigation, orientation of intramuscular motor endpoint of muscles (IME), is described. IME location diagrams and ultrasound picture of muscles are presented. Scales are proposed to assess the effect of spasticity on the functions of the upper and lower limbs. In conclusion, a variant of complex treatment of spasticity and original patient models are proposed, the use of which makes it possible to calculate the cost of BoNT.

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Section: Scales For Assessing Spasticity and Disorders Of Activity Anmentioning

confidence: 99%

“…Alexander Kovalenko 1,2 *, Viktor Misikov 3 , Konstantin Sinelnikov 4 , Valeriy Shamigulov 5 , Dmitrii Iskra 1,6 , Svetlana E. Khatkova 7 and Denis V.…”

Section: Author Detailsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Spasticity: Diagnosis and Treatment

Коваленко¹,

Мисиков²,

Sinelnikov³

et al. 2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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“…Фокальная и сегментарная спастичность является основным препятствием для реабилитации пациентов с синдромом верхнего мотонейрона и имеет значительную популяционную распространенность (свыше 12 млн человек) [1]. Активное внедрение в клиническую практику ботулинотерапии стало прорывом в лечении спастичности [2].…”

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Mapping the limb muscle motor points for targeted administration of botulinum toxin in the treatment of focal and segmental spasticity

Коваленко

Sinelnikov²,

Shamigulov

et al. 2020

RJTAO

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Spasticity treatment remains an urgent problem of modern neurorehabilitation. The targeted injection of botulinum neurotoxin (BoNT) into the muscle motor points (MPs) is gaining more and more popularity. But there are insufficient data on the position of MPs, while a MP search methodology has not been worked out yet. Most information about MPs has been obtained on cadaveric material using anatomical dissection or Sihler’s staining technique. Clinical data on the targeted injection of BoNT into the MPs are contradictory, which may be due to the inaccurate determination of their position.Objective: to verify upper and lower limb muscle MPs through electromyography (EMG).Patients and methods. Forty healthy volunteers were examined and underwent anthropometric assessment. Upper and lower limb muscle projections were completely scanned using EMG and ultrasound.Results and discussion. The anatomical localization of MPs in the upper and lower limb muscles involved in spasticity patterns was determined. The position of MPs was found to populationally identical, to have a slight deviation associated with the limb length, and to be unrelated to gender, age, and limb dominance. Original tables and maps for limb MP localization were created.Conclusion. The findings can enhance the efficiency of BoNT administration and improve the quality of rehabilitation measures, since the use of reliable information on the position of MPs will allow targeted BoNT injection in the immediate vicinity of the site of biological action. In clinical practice, this opens a window of opportunity for the early initiation of rehabilitation measures aimed at restoring movement.

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