Symptomatic therapy for spasticity

Spasticity is a violation of muscle tone that occurs with central paralysis, is characterized by an increase in tonic stretch reflexes, is associated with an increase in tendon reflexes and other signs of damage to the central motor neuron [19, 22]. A large number of works are devoted to the mechanisms of its formation and clinical phenomenology in various diseases accompanied by damage to the central motor neurons [11, 19, 21, 22, 25]. It is known that spasticity is not the result of a violation of any one system - the spinal or cerebral, or one neurophysiological mechanism, but is caused by presynaptic disinhibition of GABAergic 1A terminals, a decrease in glycerinergic reciprocal inhibition, hyperexcitable depressive alpha motoneurons, 1 glycerinergic inhibition [14, 25]. Since spasticity cannot be explained by any one type of pathophysiological disorder and includes changes in both pre- and postsynaptic inhibition, it is difficult to develop an effective treatment for it. However, there are certain drugs, surgical manipulations, methods of restorative treatment, which, to one degree or another, reduce the manifestations of spasticity. Before starting such treatment, it is necessary to analyze all the facts in the clinical picture of a particular patient. First, it is necessary to decide whether the spasticity is sufficiently pronounced and whether this justifies the conduct of special therapy. Secondly, one should differentiate between true spasticity and changes in the mechanical properties of muscles. Finally, it is known that the severity of spasticity can be aggravated by various factors, both external (eg cold) and internal (eg, bladder infection or excitement) [14].