Strokes can come with an assortment of health complications for patients. One of these is spasticity, a disorder that affects muscle tone and tension, causing pain and impacting movement. Spasticity is a chronic condition that can lead to suffering and severe functional disorder. However, there are various types of treatment that can provide relief and restore at least some of the patient’s quality of life.
What is spasticity?
Spasticity is a condition in which there is extreme muscle tightness caused by prolonged contraction. The condition is formed in the central nervous system, in the area of the brain or spinal cord that signals the muscle to contract. When there is a disruption in one of the stations between the brain and the muscle, the command to the muscle is affected, and the muscle cannot relax — it actually contracts even more. Strokes can cause this disruption in the central nervous system, which develops over time rather than immediately after the stroke. When spasticity goes untreated, the muscles become fixed in the distorted position created. The condition should therefore be treated as soon as possible.
How does spasticity affect quality of life?
Spasticity usually affects the lower extremities, impacting the patient’s ability to move and walk. This may lead to falls and interfere with stability. The arms may also be affected, which can lead to permanent deformities in position due to contracted muscles, and to infections and injuries caused by the contracted position.
Spasticity also interferes with the important physical therapy patients must do after a stroke. The condition prevents patients from properly working on the affected limbs, interfering with the therapy process.
Spasticity also leads to pain caused by the contraction.
Early treatment can help and provide relief at all these levels and improve the patient’s quality of life.
There are various treatments that can help those who suffer from spasticity and make their lives easier.
These include oral muscle relaxants; receiving a subcutaneous pump that releases muscle relaxants directly into the spinal cord; and receiving localized injections of a muscle-relaxing toxin that partially blocks the transmission of nerve signals to the muscle.
For whom is the muscle-relaxing treatment suitable?
Not everyone affected by spasticity should be treated with the muscle-relaxing toxin. Before starting treatment, it is important to understand whether the spasticity is problematic.
Would improving the spasticity improve the patient’s function and quality of life? After a stroke, part of the problem in function stems from muscle weakness, not necessarily spasticity, and it is important to understand whether treating the spasticity will improve this condition or not. Would the treatment relieve the patient’s pain?
During treatment, it is very important to monitor the patient and ensure that there is an improvement in function and quality of life, and not just in the spasticity itself. If the treatment has the potential lead to even a seemingly minor improvement, but brings the patient happiness and relief, it is worth it.
How does treatment with the muscle-relaxing toxin work?
The treatment is performed by injecting the toxin into the muscle. The toxin blocks the neurotransmitter responsible for contracting the muscle, thus preventing the contraction.
The decision about where to inject the toxin can be made in several ways:
- Anatomical position — looking at where the muscle is located and injecting there.
- A more advanced method — using EMG or nerve stimulation to observe the activity of the muscle and ensure we are injecting in the right place.
- Another advanced method — using an ultrasound to ensure we are injecting in the best place and not harming other areas.
The treatment is safe, but there may be localized side effects, including muscle weakness caused by the toxin. For better or worse, the treatment is effective for three months. Thus, if it is deemed ineffective or harmful to the patient, its effects will be reversed after three months. However, those for whom the treatment is effective and helpful must repeat it every three months.
Want to check if you have spasticity? Fill out this questionnaire:
Spasticity Questionnaire
Where is treatment with the muscle-relaxing injection available?
There are several injection centers nationwide. The following is the complete list of centers by region.
South — Jerusalem:
- Barzilai Medical Center, neurological institute, 1st floor, outpatient clinics, Ashkelon
- Hadassah University Hospital — Ein Kerem, clinic building, 6th floor, Jerusalem
- Soroka Medical Center, Brain Center, ground floor, Beer Sheva
- Shaare Zedek Medical Center, main building, 4th floor, Jerusalem
- Hadassah University Hospital — Mt. Scopus, rehabilitation building, ground floor, Jerusalem
Center and Shfela Region:
- Tel Aviv Sourasky Medical Center (Ichilov), Founders’ Building, 4th floor, Tel Aviv
- Assuta Medical Center, HaBarzel St. 10, 1st floor, Tel Aviv
- Shamir Medical Center (Assaf Harofeh), Be’er Ya’akov
- Rabin Medical Center (Beilinson), 1st floor, Movement Disorders Clinic, Petah Tikva
- Wolfson University Medical Center, outpatient building, 1st floor, Holon
- Kaplan Medical Center, ground floor, across from the imaging institute, Rehovot
- Sheba — Tel HaShomer Medical Center, hospitalization tower, ground floor, department 9, Ramat Gan
- Tel Aviv Sourasky Medical Center (Ichilov), rehabilitation building, 2nd floor, Tel Aviv
- Herzfeld Geriatric Rehabilitation Medical Center, 1st floor, next to the visitors’ center, Gedera
- Reuth TLV Rehabilitation Hospital, outpatient clinics building, ground floor, Tel Aviv
- Sheba — Tel HaShomer Medical Center, rehabilitation building, 1st floor, Ramat Gan
North and Sharon Region
- Hillel Yaffe Medical Center, machine building, 2nd floor, Hadera
- Ziv Medical Center, ground floor, neurological clinics, Safed
- Laniado Hospital, ground floor, machines, Netanya
- Loewenstein Hospital, Fleischmann Building, 1st floor, Ra’anana
- Bnai Zion Medical Center, 6th floor, east building, Haifa
More information about spasticity on Infomed
