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Find
all of Dr. Taub’s articles on Stroke Rehabilitation
listed on the to see a list of other articles
from the private practice of Neal S. Taub, MD. |
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A Letter Released
to Physicians on June 2, 2006 A Comparison of Post-Stroke Antispasmodic Treatments Conventional treatment for
post-stroke spasticity includes any of the following approaches or some
combination of them: oral and intrathecal antispasmodics, local phenol or
alcohol injections, physical therapy, functional electrical stimulation,
and/or casting. Botulinum Toxin A
(BTX-A) serves as another post-stroke antispasmodic treatment growing in
popularity among physiatrists. BTX-A
offers numerous advantages over other antispasmodic treatments. BTX-A: Seven
percent of post-stroke patients report side-effects such as discomfort at an
injection site, headaches, and flu-like illness.1 However, side effects are generally mild
and the treatments are generally well tolerated, even by geriatric
patients. One of the main hindrances
to patients receiving effective BTX-A treatments is that successful
treatments often require targeting smaller muscles such as the finger flexors
or the toe flexors as well as specialized training to discern which specific
muscles require treatment. Fortunately,
you can refer your patients within driving distance of Oral
Drugs: Oral antispasmodics such as baclofen
and dantroline present risks that include
drowsiness, nausea, headache, muscle weakness, and light-headedness. In geriatric care, where a percentage of
patients already have impaired cognition, the sedating effects of oral
antispasmodics can lead to agitation, lethargy, and falling.2,3 Oral
antispasmodics can also be habit forming.
When patients ingest antispasmodics, the drugs will weaken all
skeletal muscles, even though there may only be a specific group of muscles
associated with the disability in question.
Local injections deliver BTX-A, thereby avoiding systemic affects and
weakening of unaffected muscles. Other
Injections: In a study of patients with lower-limb spasticity,
a single treatment of BTX-A was compared with a percutaneous tibial nerve
block by 5% phenol.4 At
weeks 2 and 4, BTX-A showed a greater effect on muscle tone than percutaneous
phenol, but effects were roughly equal at 8 weeks. Both treatments improved walking velocity
and range of motion, but BTX-A created greater improvements. Adverse effects in the percutaneous phenol
group included temporary but painful dysesthesia. Intramuscular phenol injections using a 2%
solution allow for less side effects and better efficacy. For this reason, intramuscular phenol
injections may also serve as a good choice in antispasmodic treatments, even
compared to BTX-A. Both BTX-A and
phenol treatments are considered and can be delivered
at Dr. Taub’s physiatric
practice in In many cases, the patients
already receiving some sort of antispasmodic treatments are the lucky
ones. So many stroke survivors were not even given a complete course of stroke
rehabilitation following their strokes, let alone a long-term drug regimen to
deal with the functional effects. If you know stroke
survivors who suffer from spasticity or who struggle with the side-effects of oral antispasmodics, please tell them
about the Physiatry practice of Neal S. Taub, MD. |
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References 1.
2005
Annual Meeting of the American Association of Physical Medicine and
Rehabilitation, 2.
Barnes
MP. Spasticity: a rehabilitation challenge in the elderly.
Gerontology. 2001; 47(6):
295-299. 3.
Mohammed I, Hussain A. Intrathecal baclofen withdrawal syndrome? A life threatening complication of baclofen pump: a case report. BMC
Clin Pharmacol.
2004;4: 6. 4.
Kirazli Y, On AY, Kismali
B, et al. Comparison of phenol block and botulinus
toxin type A in the treatment of spastic foot after a stroke: a randomized,
double-blind trial. Am
J Phys Med Rehabil. 1998; 77: 510-5. |
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Home Stroke Rehabilitation About Neal Taub, MD What is a Physiatrist |
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