Understanding Spasticity After Stroke

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Posted by Allergan Dec 12 2017

In the United States, someone has a stroke every 40 seconds.^₁ Though stroke death rates have declined in recent decades, it is a leading cause of serious long-term disability,^₂  taking a toll on both survivors and their caregivers. It’s important to understand the many ways strokes can impact survivors, including a disabling yet often overlooked condition known as spasticity.
It is estimated that approximately one million adult stroke survivors in the United States are living with some form of spasticity,^₃  a  condition in which they experience an abnormal increase in muscle tone or stiffness of muscle.^₄ Stroke survivors may not experience spasticity immediately; in fact, it could occur weeks to months afterwards— long after a patient leaves the hospital.^₅
“The focus after someone has experienced a stroke is so commonly on preventing a second stroke that rehabilitation goals can leave patients and their caregivers feeling unprepared for a larger discussion about the post-stroke symptoms they may be experiencing, including spasticity,” said Dr. Atul Patel, Physical Medicine and Rehabilitation physician, Kansas City Bone & Joint Clinic. “It’s critical that patients and caregivers understand that even if a person has been experiencing spasticity for years, there are ways to help manage the condition.”
Spasticity is caused by damage to nerve pathways of the brain or spinal cord that control voluntary movement,^₆  and can impact limbs in both the upper and lower body. Upper limb spasticity (ULS) can affect the thumb, elbow, wrist and fingers,^₆ while lower limb spasticity (LLS) produces muscle stiffness in the ankle and toes.^₆
Patients with symptoms of spasticity can be treated by a multidisciplinary team of healthcare experts that may include a neurologist, physiatrist (specializing in physical medicine and rehabilitation), physical therapist, occupational therapist, or other specialists depending on the cause of the underlying disorder. Depending on the severity of the condition and the patient’s treatment goals, treatment options for spasticity include oral medications to reduce the tone in the muscle; physical therapy regimens, such as muscle stretching and range of motion exercises, to help prevent shortening of muscles; or an injection of botulinum toxin to help reduce muscle stiffness.^₇
Indications
BOTOX® is a prescription medicine that is injected into muscles and used:
• to treat increased muscle stiffness in elbow, wrist, finger, thumb, ankle, and toe muscles in people 18 years and older with upper and lower limb spasticity.
It is not known whether BOTOX® is safe or effective to treat increased stiffness in upper limb muscles other than those in the elbow, wrist, fingers, and thumb, or in lower limb muscles other than those in the ankle and toes. BOTOX® has not been shown to help people perform task-specific functions with upper limbs or increase movement in joints that are permanently fixed in position by stiff muscles. BOTOX® is not meant to replace existing physical therapy or other rehabilitation that may have been prescribed.
IMPORTANT SAFETY INFORMATION
BOTOX® may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:
• Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at highest risk if these problems are pre-existing before injection. Swallowing problems may last several months. Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing.
Please see additional Important Safety Information below
BOTOX®, a prescription injectable therapy, works by blocking signals from nerves to muscles, reducing those contractions caused by spasticity.  In adult patients diagnosed with upper or lower limb spasticity, BOTOX® is injected by a trained medical specialist – such as a neurologist or physiatrist – using a fine needle directly into the affected muscles.  Patients or caregivers who want to learn more about spasticity and where to find a BOTOX® specialist can visit www.botoxspasticity.com.
Living with spasticity can make some of the simplest tasks more challenging. Below are a few tips to help survivors and their caregivers:
• Stay physically active. Find an exercise routine that can be performed easily.
• Manage stress. Practice relaxation exercises, breathing exercises, gentle stretching, and other techniques to help reduce stress.
• Join a support group. Support groups can allow survivors and caregivers opportunities to share experiences with others dealing with spasticity.
Most importantly, talk to a healthcare provider about symptoms after a stroke. People who experience symptoms of spasticity should continue to seek treatment from a healthcare provider who specializes in the condition to help manage the impact of post-stroke symptoms, as well as to prevent another stroke.