How is spasticity managed in middle cerebral artery (MCA) stroke?

Updated: Feb 20, 2018
  • Author: Daniel I Slater, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Movement, in terms of both passive and active range of motion, is the most important measure to prevent loss of range of motion due to spasticity. Appropriate wheelchair positioning is also effective in decreasing spasticity. Bracing, especially at night, allows continuous passive range to tight, spastic muscle. This includes serial casting, which allows gradual increase in range over weeks. [26]

Oral medications also are often used for spasticity management, including tizanidine, baclofen, dantrolene, and benzodiazepines. . The functional benefit of these drugs is not well demonstrated despite their common use. These medications often have at least some sedating effect on patients, which should be weighed carefully in patients already with cognitive impairment and poststroke fatigue.

Several botulinum toxins are now widely used to treat more focal spasticity with injections. Studies regarding the benefits of such injections have not been conclusive in supporting the intervention. This may be due to errant needle placement, which is far more common than once appreciated, even in large muscles such as the gastrocnemius. The increased use of musculoskeletal ultrasound to guide needle placement may improve outcomes, and studies are underway.

Finally, the surgical implantation of an intrathecal baclofen pump has been shown to benefit those with particularly severe spasticity. [27]


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