Convulsions after a stroke in a bedridden patient

Muscle spasticity - what is it?

Muscle spasticity is a syndrome that develops when areas of the upper motor neurons are affected, and there is an increase in tonic reflexes as a result of stretching, combined with an increase in reflexes in the tendon area.
The concept of muscle tone means a certain level of tension in muscle groups and resistance that occurs during extension or flexion movements of a limb segment. The normal state is considered to be a feeling of some slight elasticity when palpating the muscles, as well as some muscle tension during leisurely movements. A certain increase in the tone of muscle groups is accompanied by strong resistance during passive movements. An increase in muscle tone can greatly affect the process of regeneration of previously impaired functions. A high level of muscle spasticity does not allow the implementation of intact functions, as well as the full recovery of impaired ones. At the same time, an increase in muscle tone is a compensating factor for the development of paralysis. This determines the urgent need, immediately after the start of treatment, to clearly determine how necessary and useful it is to reduce the muscle tone of a cramped arm or leg.

Causes

The occurrence of seizures after a stroke is associated with the death of neurons. The body, in order to limit the necrotic lesion and preserve the connection between nerve cells, redistributes the functions of the affected cells between healthy neurons.

The protection mechanism is implemented through the formation of a cavity that is filled with liquid. This neoplasm does not have a significant impact on the patient’s well-being and quality of life. However, in some cases it can irritate neurons, resulting in seizures.

Neurologists call the main causes of seizures that develop after a stroke, adhesions, cysts and various neoplasms. However, experts also identify factors that can provoke and aggravate convulsive syndrome:

side effects that occur when taking certain medications;
suffered stress or a state of emotional distress;
psychological and physical fatigue.

Convulsive syndrome is a dangerous consequence of a stroke, in which a shock reaction occurs in the body. Neurologists at the Yusupov Hospital use effective developments in modern medicine to eliminate the causes of seizures after a stroke.

Symptoms of spasticity

The main symptom of spasticity is involuntary muscle contraction. This process is accompanied by a headache and a general feeling of weakness throughout the body. Not always pain can be attributed to symptoms of spasticity. Very often, the cause of this condition is too sudden movements, which cause spasmodic contractions of the muscles of the arms or legs. In addition, pain can occur as a result of a change in the position of the patient's body, in particular at the moment when attempts are made to sit him down.

As a result of spastic contractions, the arms or legs cease to obey, become too weak, or acquire additional rigidity. In this case, a sick person with spastic muscle contractions may feel both weakness and some resistance from the cramped muscles. These factors are a consequence of the conduction of muscles and nerves. When taking medications, there is some relief from tense muscles, but the feeling of weakness remains.

Other symptoms of spasticity include involuntary contractions of individual muscle groups, as well as a feeling of general fatigue and loss of dexterity in the muscles. Numerous testimonies from patients characterize spasticity as excessive tension in the muscles, weakness in the legs, and resistance when moving the legs and arms.

Spasticity after stroke

Stroke is an extremely important medical and social problem, since it is one of the causes of many cases of disability, usually related to disorders of human motor activity. In the vast majority of all cases, the acute period of stroke is characterized by the detection of hemiparesis; in approximately two-thirds of all cases, the presence of residual effects after a stroke is noted. In the majority of cases, stroke occurs in people of retirement age, and women are 20% less susceptible to it than men.

Immediately after the onset of a stroke, there is a decrease in muscle tone in the limbs, but after three days it recovers, eventually returning to average values. Depending on the severity of the stroke, the duration of the painful condition and the degree of muscle spasticity may vary. The basis of spasticity after a stroke is a disruption of the activity of the parts of the human cerebral cortex responsible for the motor activity of the limbs.

Spasticity with cerebral palsy

The spastic form of cerebral palsy is a very common phenomenon. At the same time, individual muscles of the child’s body are in increased tone, which occurs due to failures in the full functioning of the muscles of the arms and legs. A state of extreme tension is very typical for muscles with cerebral palsy and this is the cause of a strong slowdown in their growth. In this case, there is a significantly faster growth of bones than muscles, which causes a significant difference in the length of muscles compared to bones and tendons. In this case, there is a decrease in the size of the affected limb and the joints of this limb become less mobile.

To prevent all this from happening, immediately after the child is diagnosed with cerebral palsy, classes should be conducted with him. You can start with regular exercises using physical therapy exercises, the results of which will determine the methods of combating spasticity. Such an approach will help achieve the necessary results.

Spasticity in multiple sclerosis

Spasticity is a symptom that is directly related to multiple sclerosis. However, when describing the symptoms of their condition, patients do not always interpret it correctly. Often, by spasm they mean a sharp wave of surging pain, while a spasm is an involuntary contraction of muscle groups. To avoid confusion, the meaning of these terms should be understood.

Spasticity in people suffering from multiple sclerosis often manifests itself in the form of unexpected contractions of certain muscles. These contractions may occur spontaneously or may be a reaction of the body to external stimuli. The degree of manifestation of such symptoms is very diverse, from a mild form to severe spasms that last a long time. In this case, the patient will need to move in a wheelchair. In multiple sclerosis, spasticity may change over time. In this case, the muscles of the arms and legs are mainly involved, and much less frequently the muscles of the back or other parts of the body.

There are some cases in which spasmodic muscle contractions may even be beneficial. This refers to conditions in which the sick person is too weak in the legs and spasm helps him to take a stable position. In this case, when spasticity is removed, the person’s legs give way and he will not be able to stand on his own.

Development mechanism

To better understand the mechanism of development of muscle hypertonicity, let's consider the main aspects of movement regulation.
The earlier classes to prevent spasticity begin, the better the result.

Normally, muscle contractions are regulated at three levels:

spinal cord;
stem nuclei of the brain;
cortex.

Any of these sections can stimulate muscle contraction. Thanks to the close cooperation of these departments, a person can perform the necessary movements, and muscle tone remains normal.

Impulses from motor neurons in the spinal cord provide automatic movements, such as sudden flexion when exposed to a painful stimulus. The overlying sections have a regulatory effect on the motor cells of the spinal cord, and it can be both inhibitory and stimulating.

The brainstem nuclei are responsible for maintaining posture and balance. The vestibular nucleus increases the tone of the muscles that extend the limbs. The red core, on the contrary, bends the limbs. In this case, spinal motor neurons of opposite muscle groups are inhibited. This relationship is called reciprocal.

The motor cortex of the brain has an inhibitory effect on spinal motor neurons, which ensures holistic movements rather than individual muscle twitches. In a patient after a stroke, damaged areas of the cerebral cortex lose their inhibitory effect on underlying structures. Externally, this is manifested by the development of muscle hypertonicity.

Spasticity treatment

Treatment methods for spasticity can be different, some of them can be distinguished:

Physiotherapy is used to stretch muscle groups and maintain joint mobility, while reducing the risk of injury. When muscle mobility is low, physiotherapy can be used as a means of gradually and smoothly stretching them. In some cases, it may be advisable to undergo minor surgery to increase the length of the ligament by making an incision in the leg;
Drug therapy is used in cases where it is necessary to take medications to relieve increased tension in the leg muscles. The mechanism of action may be different; some drugs affect the spinal cord, others affect brain receptors;
Botulinum toxin is a remedy that provides the appropriate effect when used when it is necessary to relax a spastic muscle for a short time. Ethanol or phenol can be considered an alternative, despite the fact that these drugs are suitable for short-term innervation of large and strong muscles, which may cause pain in certain nerves.

Exercise for spasticity

Spasticity manifests itself as a violation of motor activity, manifested in partial or complete immobility, increased muscle tone, as well as involuntary movements. There are certain exercises that can reduce spasticity, restore motor activity and eliminate synkinesis in paralyzed limbs.

Performing exercises requires a certain synchronicity, and both affected limbs participate in them, moving in the same direction at different or the same speed. You can do the exercises yourself, or you can use someone else’s help. Execution involves an average and slow pace, the number of repetitions is limited to four. You can rest by placing your arm or leg in a position that relaxes the muscles most effectively.

Massage for spasticity

For spasticity, the following massage methods can be used. The arms are joined on the chest, the legs are pulled towards the abdominal area, the body bends slightly and in this position you can carry out free light rocking, which ensures a decrease in muscle tone after a certain time. The time during which a decrease in muscle tone occurs should be used to provide high-quality stimulation for the restoration of certain motor functions that were impaired as a result of muscle spasm. When muscle tone increases, it is recommended to repeat the described massage method. This technique is most effective when applied to children aged from one month to seven years.

You can use a form of massage that normalizes muscle tone using a ball. To do this, you need to lie on the ball with your chest and stomach, then make a series of movements in different planes, then change the position of your body and lie on your back on the ball, subsequently repeating the entire listed set of movements. Depending on the muscle tone at the time of the exercise, the duration of the exercise should be determined. On average, this type of massage takes no more than fifteen minutes a day.

Folk remedies

For spasticity of the lower extremities, the following traditional medicine is recommended for use. It is necessary to sew bags according to the shape of the legs and the area of the torso up to the lumbar spine, which are subsequently filled with birch leaves torn from the tree. Immediately before going to bed, the patient should be placed with his feet in these bags and kept in them for some time, while ensuring that the leaves fit the person’s body in a dense layer on all sides as tightly as possible. This is necessary to create the necessary temperature environment in the bags so that the person sweats well. At the same time, your feet sweat just as profusely as they would when using a steam bath. It is recommended to stay in this position all night. In some cases, it may be advisable to replace the leaves around midnight if they become very wet. After completing several such sessions, spastic manifestations in the lower extremities will cease to bother you.

Stroke and muscle hypertonicity

The development of C in cases of damage to the structures of the central nervous system is associated with a decrease in inhibitory effects on spinal motor neurons [2,3]. The decrease in inhibitory effects on spinal structures is explained by combined damage to the pyramidal and extrapyramidal tracts of the brain, while an important role in the development of spasticity is attributed to damage to the cortico-reticulospinal tract [2–4]. In conditions of weakening of corticospinal stimuli, dysfunction of the extrapyramidal system can usually be observed. One of the leading mechanisms of C formation should be considered the disinhibition of the tonic stretch reflex. Secondary changes in the muscles, tendons and joints that occur with muscle hypertension increase movement disorders; therefore, resistance to passive movement depends not only on disturbances in muscle tone, but also on muscle changes, in which signs of atrophy can often be found. An isolated lesion of the pyramidal tract, as a rule, does not cause hypertonicity, but only leads to paresis. However, with stroke, damage usually occurs not only to the pyramidal tract, but also to other structures, such as the cortico-reticular-spinal tract, which leads to inevitable disturbances in muscle tone. If post-stroke paresis persists for a long time (several months or more), then structural changes in the segmental apparatus of the spinal cord may occur (shortening of the dendrites of motor neurons and collateral sprouting of afferent fibers that make up the dorsal roots), which contribute to a sustainable restructuring of the motor stereotype [2, 5,6]. This is facilitated by secondary changes in muscles, tendons and joints, which increase the resistance that occurs in the muscle when it is stretched [7,8]. Knowledge about the pathogenesis of tonic disorders arising in connection with stroke is necessary to understand the mechanisms of action of drugs, most of which have a so-called central mechanism of action. It is possible to detect the first signs of increasing muscle-tonic disorders already in the first hours after a stroke. They are often characterized by a decrease in muscle tone. However, after a few days, spasticity becomes noticeable and increases along with the restoration of movements. The functional state of muscles and muscle tone are assessed during a standard neurological examination of the patient, during observation of active movements, and during passive changes in the position in space of body parts. Spasticity is characterized by increased muscle tone, which prevents the expansion of range of motion. Each time when performing the simplest movements, the patient has to overcome the resistance of tense muscles, which aggravates the picture of paresis or paralysis. A characteristic clinical sign of C is its change during the study - the tone increases with passive stretching of the muscle, and the increase in muscle resistance directly depends on the speed of passive movement. A common sign that reveals dystonia is uneven muscle tone during flexion and extension of the limb - the “jackknife” phenomenon. The degree of muscle tone disorders can vary significantly during the day, under the influence of external and internal factors (weather, emotional state of the patient, ambient temperature). Patients who have suffered a stroke are characterized by changes in tone depending on the position of the limb, physical activity, its nature and intensity. Hypertonicity can delay recovery after a stroke, since with severe muscular dystonia, the patient’s daily activity is limited to the confines of the bed: with any attempts to move to a vertical position, persistent muscle tension prevents movement and forces the patient to return to a horizontal position. Other complications of the post-stroke period also arise - limited mobility in joints, arthrosis-arthritis and associated pain syndromes. Muscular dystonia has a significant impact on the statics of the spine, which in some cases becomes an independent problem (lumbodynia, thoracalgia, vertebrogenic radiculopathies). One of the most important questions that must be addressed when managing a patient with post-stroke spasticity comes down to the following: does high muscle tone worsen the patient’s functional capabilities? In general, limb functionality in patients with post-stroke limb paresis is worse in the presence of severe spasticity than in mild spasticity. At the same time, in some patients with severe paresis, spasticity in the leg muscles can make standing and walking easier, and its decrease can lead to deterioration in motor function and even falls [7–9]. Before you begin to correct hypertonicity, it is necessary to determine treatment options in this particular case (improving motor functions, reducing painful spasms, facilitating patient care, etc.) and discuss them with the patient and (or) his relatives. Treatment options are largely determined by the time since the disease and the degree of paresis, the presence of cognitive disorders [2,7]. The shorter the time since the stroke that caused spastic paresis, the more likely it is to improve. With a long duration of the disease, a significant improvement in motor functions is less likely, however, it is possible to significantly facilitate patient care and relieve the discomfort caused by S. The lower the degree of paresis in the limb, the more likely it is that treatment will improve motor functions [3,5]. For clinical assessment of muscle tone and monitoring the effectiveness of treatment, the modified Ashworth scale is used for practical purposes (Table 1). The principles of spasticity correction in the post-stroke period are based on the following principles: - pathologically increased muscle tone should be reduced in all cases to prevent irreversible changes in muscles and joints and speed up the rehabilitation process; - treatment should be started as early as possible, when the first signs of C appear; — the duration of treatment is determined by the restoration of the patient’s motor activity. Drug therapy for muscle dystonia in patients who have suffered a stroke is based on the use of muscle relaxants. Before prescribing muscle relaxants, it is necessary to establish how much increased muscle tone makes movement difficult. In some cases (especially in the early recovery period), hypertonicity helps the patient maintain support on the paretic limb - then the prescription of muscle relaxants can be delayed. However, this feature usually requires attention for a short period of time - during the patient's first attempts to restore walking skills. In the future, a decrease in muscle tone plays a more important role in comprehensive rehabilitation programs, as it allows for an increase in range of motion. Tolperisone is most often used to treat spastic syndromes. In its chemical structure, the drug is close to lidocaine. The action of the drug is based on the blockade of polysynaptic spinal reflexes. In addition, the drug has a central anticholinergic effect, has antispasmodic and moderate vasodilator activity. Tolperisone reduces increased muscle tone and muscle rigidity during spastic paresis, improves voluntary active movements, normalizes peripheral circulation, and has a membrane-stabilizing, local anesthetic effect. Its use in adequate doses leads to increased local blood circulation. The main contraindication for use is myasthenia gravis and lidocaine intolerance. Typically, the start of treatment occurs in the 2nd–3rd week of a stroke - the period of activation of the patient. When the first signs of spasticity appear, 50–100 mg of the drug per day is prescribed, which in most cases facilitates movement. In later periods of the disease, with the formation of persistent spastic paresis, higher doses of muscle relaxants are required. In severe cases of increasing spasticity, intramuscular administration of the drug 100 mg 2 times a day is used. Tablets of 50 and 150 mg allow you to act in a wide range of therapeutic doses to achieve the desired effect. The vasodilating effect of tolperisone may be useful in cases of severe atherosclerotic changes in the vessels of the lower extremities. The drug combines well with non-steroidal anti-inflammatory drugs. It is important to note that the drug does not cause general muscle weakness. Tolperisone does not have a sedative effect. Other agents are used to correct spasticity of various origins: tizanidine, baclofen, dantrolene and benzodiazepines. The basis for the use of these antispastic drugs (or muscle relaxants) are the results of double-blind placebo-controlled randomized studies that showed the safety and effectiveness of these drugs [8–10]. An analysis of studies comparing the use of various antispastic agents in a variety of neurological diseases accompanied by spasticity showed that tizanidine, baclofen and diazepam are able to reduce spasticity to approximately the same extent [10]. In stroke patients who have local spasticity in paretic muscles, botulinum toxin type A or botulinum toxin can be used. The effect of botulinum toxin when administered intramuscularly is caused by blocking neuromuscular transmission. The clinical effect after injection of botulinum toxin is observed after a few days and lasts for 2-6 months, after which a repeat injection may be required. The best results are observed when using botulinum toxin in the early stages (up to a year) from the moment of illness and with mild paresis of the limb. The use of botulinum toxin may be especially effective in cases where there is a foot deformity caused by spasticity of the posterior leg muscles, or high tone of the flexor muscles of the wrist and fingers, which impairs the motor function of the paretic hand [2,10,11]. Repeated injections of botulinum toxin in some patients give a less significant effect, which is associated with the formation of antibodies to botulinum toxin and blocking its action. The limited use of botulinum toxin in clinical practice is largely due to the high cost of the drug. Treatment with muscle relaxants begins with a minimum dose, then it is slowly increased to achieve effect. Antispastic agents are usually not combined. Surgical treatment for post-stroke spasticity is also possible. Surgical operations to reduce spasticity are possible at four levels - the brain, spinal cord, peripheral nerves and muscles [11,12]. Brain surgeries include electrocoagulation of the globus pallidus, ventrolateral nucleus of the thalamus, or cerebellum and implantation of a stimulator on the surface of the cerebellum. A longitudinal dissection of the conus (longitudinal myelotomy) can be performed on the spinal cord to sever the reflex arc between the anterior and posterior horns of the spinal cord. The operation is used for spasticity of the lower extremities; it is technically complex, associated with a high risk of complications, and therefore is rarely used. A significant part of surgical operations in patients with spasticity of various origins is performed on muscles or their tendons. When contracture develops, surgical intervention on the muscles or their tendons is often the only method of treating spasticity. So, drug correction of muscular dystonia is carried out mainly with muscle relaxants, but in necessary cases, to reduce muscle tone, it is possible to use representatives of other drug groups that act on different levels of the pathological process. In each specific case, the treatment regimen and dosage of medications are determined individually. It should be noted that the correction of muscle-tonic disorders is achieved by complex treatment, which includes properly organized and systematic physical therapy, massage, and reflexology [11,12]. Several types of exercise are usually recommended for stroke patients. The so-called general tonic and breathing exercises (helping to improve the general condition of the body), exercises to improve coordination and balance, to restore the strength of paralyzed muscles, as well as techniques to reduce muscle tone are used. Along with therapeutic exercises, positioning or positional treatment is also used, in which the patient is specially placed in bed so as to create the best conditions for restoring the functions of his arm and leg [9].

Literature 1. Gusev EI. The problem of stroke in Russia. Journal of Neurology and Psychiatry. S.S. Korsakova (STROKE supplement to the journal). 2003; 9:3–7. 2. Parfenov V.A. Spasticity in the book: The use of Botox (botulism toxin type A) in clinical practice: a guide for doctors. Ed. O.R. Orlova, N.N. Yakhno. – M.: Catalog, 2001 – p. 108–123. 3. Formisano R., Pantano P., Buzzi MG et al. Late motor recovery is influenced by muscle tone changes after stroke // Arch Phys Med Rehabil. – 2005; 86:308–11. 4. Shirokov E.A. Sirdalud in the complex therapy of chronic pain syndromes//RMZh, 2006; 4:240–242. 5. Coward DM Tizanidine: Neuropharmacology and mechanism of action. //Neurology. 1994;11(9):S6–S11. 6. Hutchinson D.R. Tizadinine with modified release (review).//RMZh, 2007;12: 1– 4. 7. Kadykov A.S. Rehabilitation after a stroke. M.: Miklos Publishing House. – 176 p. 8. Gelber DA, Good DC, Dromerick A. et al. Open–Label Dose–Titration Safety and Efficacy Study of Tizanidine Hydrochloride in the Treatment of Spasticity Associated With Chronic Stroke // Stroke. 2001; 32:2127–31. 9. Kamchatnov P.R. Spasticity - modern approaches to therapy. https://www.medlinks.ru/article.php?sid=20428 10. Bakheit AM, Thilmann AF, Ward AB et al. A randomized, double–blind, placebo–controlled, dose–ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke // Stroke. 2000; 31:2402–06. 11. Francisco GF, Boake C. Improvement in walking speed in poststroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study // Arch Phys Med Rehabil. 2003; 84:1194–9. 12. Ward AB A summary of spasticity management – a treatment algorithm // Eur. J. Neurol. 2002; 9(1): 48–52.

Spasticity in children

Spasticity in children is the most acceptable variant of hypertonicity, which disappears after several stroking movements; in any case, a sharp decrease in spasticity may be noted. You should not waste time if you notice a similar symptom in a child; you should actively move the abducted limb as quickly as possible or perform a series of passive movements. Spasticity in children can be a consequence of various injuries or diseases. Most often, spastic muscle contractions plague disabled children suffering from cerebral palsy; its manifestations are also possible in multiple sclerosis, traumatic brain injuries and traumatic injuries to various parts of the spine. In all these cases, eliminating spasticity is much more difficult.

Spasticity in children is essentially an involuntary contraction of individual muscle groups. Symptoms can appear completely involuntarily, since in this situation there is no control over the energy consumed by the leg muscles. The commands given by the brain are perceived by the muscles completely incorrectly, which causes their spontaneous contractions.

2556. Ilya

| 30.11.2013, 18:40:34

Listen, please, everyone!

I myself am an instructor in restoring movements using wave techniques, and the author of the insult5.ru project.

2557. Ilya

| 30.11.2013, 18:40:50

In addition, the muscles on the affected side are weak, atrophied, and it is basically impossible to strengthen them with pills, injections, or massagers.

We have a technique, a training video, and results for a 68-year-old man, after a terrible hemorrhagic stroke and paralysis, after 5 months. classes, the abs pump, and he walks with light support.

Our other student (54 years old, with craniotomy, movement coordination disorder, barely able to move, with severe spasticity of the arm and paralysis of the leg) after 3 weeks of classes began to stand up on his own without support and stand upright (classes continue)

Another client (72 years old, ischemic stroke 3 years ago, lack of any rehabilitation, contracture + paralysis of the left arm) during the 2nd lesson was able to move it to a bend, 10 cm, and lift it by 5 cm.

So, dear forum users! From my own experience, I want to say (I can no longer remain silent, reading some comments) MOVEMENT DISORDER IS TREATED MAINLY BY CORRECTLY ORGANIZED, GENTLE MOVEMENT, A COMBINATION OF DYNAMIC AND WAVE LOAD. (And the fact that they grumble and sometimes make you nervous with their behavior - they are like children, they don’t need pity, and not punishment in the form of: “Oh, you’re so! I’m not coming!” THEY ONLY NEED HELP IN RESTORING MOTOR SKILLS, THE REST THEY WILL DO IT THEMSELVES: go to the toilet, shave, eat, etc.

I don't want to be unfounded. And I suggest that those who really need help here, and not “just complain,” take a course to restore movements at home. Go here: insult5.ru. I myself will guide you, advise you, and send you the necessary exercises. And you will post here on the forum about the results. This will help you and give hope to many other people. I can help those in Moscow personally.

Muscle spasticity - Jekyll and Hyde?

What is this?

To some extent, muscle spasticity may be temporarily beneficial at the end of the "flaccid phase" of recovery.

Immediately after a stroke, some patients experience flaccidity (weakness) in the muscles on the affected side. A person who has had a stroke cannot move anything independently on the injured side. This is a terrible time for stroke survivors and their families. It's a cruel joke that people are in such a bad state immediately after a stroke, when they are least able to understand what happened and react to it.

Research shows that people whose muscle flaccidity persists for a year after a stroke can only hope for limited recovery. But some patients who notice muscle flaccidity actually do not have it. Part of the problem lies in the terms used to describe the movement disorder. Often the word "paralyzed" is used instead of the word "hemiparetic". Hemiparesis involves weakness on one side of the body rather than paralysis. There are only two types of true paralysis after a stroke:

Flaccid paralysis (muscles do not contract - do not bend limbs, do not activate or move).
Spastic paralysis (muscles are so tense from spasticity that a stroke survivor cannot move them).

These forms of paralysis are rare. Most stroke survivors fall into the general category of “hemiparetics.”

Some people think that this distinction does not matter, but they are wrong. Small movements can be used as a starting point for mastering much better and more coordinated movements. Therefore, there is a huge difference between “no movement” and “small movements”. If a person’s muscle flaccidity persists for a year, then the prognosis for the restoration of movements is unfavorable. When a patient has small movements, it means that they have intact connections between the brain and muscles, and increasing these connections indicates that there is potential for improved movement.

The stages of stroke recovery described by Brunnström show that as people recover, they begin with a flaccid phase and then enter a muscle spasticity phase. The presence of muscle spasticity is seen as a period of hope because the muscle's ability to contract is finally restored. Small synergistic movements .

According to the stages proposed by Brunnström, after a period of flaccidity, muscle spasticity appears. Can spasticity be viewed in some positive light? There are actually negative and positive aspects to this phenomenon.

How it's done?

Muscle spasticity is harmful because it:

contracts muscles and other soft tissues , which can lead to their permanent shortening ( contracture );
keeps joints in the wrong position, which reduces the functionality of the limbs;
interferes with normal activities;
may cause pain;
may cause insomnia;
may cause deformation;
may interfere with weight gain (contracted muscles burn a lot of calories);
may cause bedsores.

Muscle spasticity is useful because:

it is a defense in cases of “unilateral neglect” (where the stroke survivor is partially or completely unaware of the affected party). For example, with muscle spasticity in the arm and hand, the limb will be pressed against the body. This may be better than a flaccid state in which the limb dangles freely and there is a possibility of injury to the fingers and hand;
it is a step in the right direction from a state of lethargy;
it can increase bone strength (according to Wolff's law ), reducing the risk of osteoporosis;
it can be used to compensate for lack of strength when standing, walking and grasping;
sometimes it helps to change body position (for example, from sitting to standing);
it can improve blood circulation, preventing blood clots and swelling;
it maintains muscle mass.

What precautions should you take?

The appearance of muscle spasticity can be considered a positive sign on the road to recovery. But once muscle spasticity occurs, the next stage of recovery requires its reduction and eventual elimination. As is true of much of the stroke recovery process, while one job is being done, another is already beginning.

Where does spasticity come from after a stroke?

The muscles of a person who does not suffer from spasticity after a stroke, during any action (movement, maintaining a posture) work in concert - some stretch (agonists), others contract (antagonists). Moreover, most of the movements are carried out unconsciously. A person does not need to think about how to change muscle tone in order to take a step. These processes occur automatically at the level of the spinal cord. One of the reflexes that allows you to unconsciously carry out movements is the stretch reflex.

To make it clear, remember your appointment with a neurologist.

The doctor knocks on the arms and legs with a hammer; during the impact, the arms and legs move spontaneously. This process is usually especially popular with patients. But what's going on? The doctor knocks on the muscle tendon; when the hammer is applied, it stretches.

Hyperstretching of the tendon gives a signal that antagonist muscles need to be activated in order to return the stretched muscle to its previous state. This is an instant reaction that is expressed in the movement of the arms and legs in response to the impact of the hammer. This reflex arc closes at the level of the spinal cord and does not involve the brain. But in everyday life, during movement, the brain always controls this reflex.

If a person does not suffer from spasticity after a stroke, during movement (especially during sharp, fast actions), the muscles are constantly stretched, but the reaction, as when exposed to a hammer, does not occur. The brain sends special inhibitory impulses that prevent the reflex from becoming hyperexcited. During a vascular accident, the cells that send these impulses die and the reflex gets out of control. Spasticity occurs after a stroke.

Mechanism of spasticity formation

Experts call the main reason for the formation of seizures an imbalance of the inhibitory effect of the motor elements of the cerebral cortex on cells in the structure of the spinal cord.

The natural result is the disinhibition of the tonic reflex - muscle spasticity is formed in the injured limbs of a person.

In a normal state, a person does not have to think about the order of the phenomena produced in the muscles: which of them first needs to be contracted, then relaxed - our brain has brought such activity to automatism.

After a stroke or injury, the death of cellular elements responsible for special inhibitory impulses in the motor neurons of the brain and spinal cord occurs. Reflex arc: limb - spinal cord - brain ceases to be a single system - coordination is impaired.

Spasms do not form immediately - over the course of weeks and even months. Leads to significant secondary changes in muscles and joints - enhances the negative impact of paresis on the motor system.

Drug treatment of spasticity after stroke.

The selection of drugs that affect spasticity after a stroke requires patience. You need to gradually increase the dose and see how it affects muscle tone. If it doesn’t work, change it, increase the dose again and see.

There are 2 groups of drugs that can affect spasticity after a stroke:

Centrally acting drugs

– provide inhibition of the reflex through the central nervous system.

non-benzodiazepine tranquilizers (Diazepam, Clonazepam),
anticonvulsants (Finlepsin, Gabapentin, Pregabalin),
alpha adrenergic agonists (Clonidine).

These drugs have one drawback - their use can cause sedation, decreased memory, attention, intelligence, and dizziness. This may have a negative impact on rehabilitation. Increasing your dose gradually will help reduce the likelihood of these side effects.

Peripheral drugs

– “extinguish” the stretch reflex at the level of the spinal cord. These include well-known muscle relaxants (Mydocalm, Sirdalud, Baclofen). The downside of the drugs is a general decrease in muscle tone. Those. they reduce tone in both spasmed and stretched muscles. Therefore, their use must be combined with gymnastics.

What is spasticity?

Spasticity manifests itself in stiffness.
It is impossible to make a fast or sudden movement. Constantly tense muscles block freedom. Feeling like you are a very rusty Terminator))). Tension leads to rapid fatigue. Recovery from a stroke can actually be blocked by spasticity. It is difficult to restore skills when the limbs seem to be tied with rubber bands and are always in a tense, unnatural position. To relieve spasticity after a stroke, we use basic exercises. The main thing is to do them easily, without stress.

Muscle spasticity is an involuntary contraction, cramp or spasm due to disruption of the conduction of nerve impulses after a spinal cord or brain injury.

Most often this condition manifests itself at night, but it can also significantly complicate life during the day.

Treatment of spasticity with botulinum toxin injections.

The next stages of influencing spasticity after a stroke is the use of botulinum toxin injections (Botox, Dysport, Xeomin). This is indicated when the tone is very large and other methods do not help. Botulinum toxin acts at the muscle level, blocking the impulses of the stretch reflex.

A very important point - after botulinum toxin injection, you need to actively engage in gymnastics for 3 months, otherwise the effect will not be lasting.

Muscle spasticity after a stroke is an increase in muscle tone, which significantly reduces the quality of life.

Muscle contraction as a tensile impulse occurs against the background of mono- or hemiparesis (unilateral and bilateral paralysis, respectively).

The cause of such processes is damage to the cells of the motor pathways of the brain. The following areas are susceptible to post-stroke spasticity:

hands;
legs;
shoulders;
hip.

With a long stay in a supine position, the symptoms gradually increase.

A positive trend is observed in the restoration of motor functions, which is achieved by various methods.

Spasticity after stroke:

drug treatment The success of therapy directly depends on the time that has passed since the disease.

The earlier treatment is started, the better the prognosis for recovery. The best results can be achieved when recovery begins in the first months after the stroke, but no later than a year later.

To immobilize a muscle group by blocking neural transmission, botulinum toxins are administered (Dysport, Xeomin, Botox). The effect lasts for an average of six months, after which repeated administration of botulinum toxic drugs may be required.

Baclofen.
Mydocal;
Sirdalud.

Baclofen for stroke from spasticity

The baclofen pump is used intrarectally. Acts at the spinal level by reducing the production of a number of amino acids (aspartate, glutamate).

In addition to relieving spasticity, a centrally acting muscle relaxant helps achieve significant success in reducing dystonic disorders, as well as minimizing pain.

Side effects:

bowel disorders (diarrhea, constipation);
drowsiness;
decrease in blood pressure.

The dosage regimen involves a systematic increase in dosage from 15 to 60 mg per day.

Treatment with botulinum toxin

The use of botulinum toxin for the treatment of hypertonicity is indicated for post-stroke patients with local spasticity.

Main indications for the use of botulinum toxin:

absence of contractures;
severe pain syndrome;
impaired motor function associated with increased muscle tone.

The mechanism of action is to block the transmission of impulses from a nerve cell to a muscle fiber. The clinical effect develops a few days after the injection and lasts for 2–6 months, depending on the individual characteristics of the patient. Due to the production of antibodies, repeated injections do not eliminate hypertension as effectively.

This method is not widely used in the fight against hypertension in patients after a stroke. This is primarily due to the high cost of the drug.

Spasticity after a stroke: treatment with folk remedies

Popular methods:

Applying heat to the spasmodic area (applying warm compresses, bags of salt or cereals).
Bandaging the upper and/or lower extremities.
Light massage (in the form of stroking and rubbing).
Taking warm baths (not hot!).
Kinesio taping.
Taking herbs.

Teas and tinctures are made from the following components:

calendula;
horse chestnut flowers or fruits;
raspberries;
rowan bark;
Melissa;
oats;
blackthorn.

Hand spasticity after a stroke is eliminated by creating a bathhouse effect.

The limb is placed in a bag with birch leaves, which is fixed and left overnight. They work similarly with spasticity in the legs, provided that the dimensions of the container correspond to the length of the limb to the lower back.

Treatment of spasticity after a stroke with acupuncture Acupuncture is a popular treatment method in post-Soviet countries, but clinical studies conducted abroad do not confirm the effectiveness of this technique. Exercises for spasticity after a stroke

This is the most effective way to combat such an unpleasant consequence. The loads should not be too exhausting, since excessive intensity only worsens the patient’s condition (the tone increases).

Cognitive impairment after stroke: risk of dementia

Dementia is a common complication of stroke. If the burning and cutting pain after a stroke are intense symptoms that quickly intensify, then dementia develops gradually.

Statistics indicate that up to 35% of people who have had a stroke will develop dementia. However, with timely treatment, abandonment of bad habits and the absence of concomitant pathologies, the likelihood of this complication is low.

The Neurology and Rehabilitation Clinic provides emergency care to patients after a stroke, as specialists work 24 hours a day, 7 days a week. You can make an appointment with a neurologist or rehabilitation specialist by calling the Yusupov Hospital.