Spasticity Meds

Question 1

Reversible and focal Rx

Answer 1

Injectables (phenol and Botox)

Question 2

Reversible and general Rx

Answer 2

Oral meds and intrathecal baclofen pump

Question 3

Botulinum Toxin

Answer 3

Injected into the muslce - absorbed in presynaptic terminal - binds to synaptic vesicles with ACH - inhibit release of ACH - no more transmission
— WEARS OFF OVER TIME
— GREAT BUT HAS TO BE DONE AS AN ADJUNCT THERAPY

Question 4

Phenol

Answer 4

Causes neurolysis — wallerian degeneration of the nerve so it targets larger muscle in LE.
Common nerve = obturator
Lasts 6-12 months
Complications
- injection site infection
- desensitization/neuralgia
- local edema
- venous thrombosis
- compartment syndrome
- death

Question 5

Baclofen

Answer 5

GABA Agonists
- metabolized in kidney
- acts at level of SC — decreases tone, spasms, clonus

Question 6

Diazepam

Answer 6

GABA B RC couple
- metabolized by liver
- increases effects of GABA at level of SC by binding benzo Rs
- physiologic dependence
- causes CNS depression

Question 7

Tizanidine

Answer 7

Alpha 2 adrenergic agonists
- metabolized by liver
- central and spinal blocking release of excitatory catecholamines
- may result in sedation and hypotension
- better tolerated for older adults

Question 8

Dantrolene Sodium

Answer 8

• acts on peripheral skeletal muscle fibers by inhibiting calcium from SR which affects muscle’s ability to contract
• decreases spasms and clonus
• may exacerbate mm weakness and fatigue

Question 9

Diazepam side effects

Answer 9

Sedation
Behavioral changes

Question 10

Baclofen side effects

Answer 10

• sedation
• hypotension
• nausea and vomitting
• weakness

Question 11

Dantrolene sodium side effects

Answer 11

• sedation
• N+V
• weakness
• hepatitis

Question 12

Tizanidine side effects

Answer 12

• sedation
• hypotension
• weakness
• hepatitis

Question 13

PROS and CONS to oral therapies

Answer 13

Pros - treats generalized spasticity and variety of drugs available
Cons - systemic SE

Question 14

PROS and CONS to phenol injections

Answer 14

Pros - potentially effective for focal spasticity, low cost, early onset of action
Cons - injection site pain, high incidence of dysesthesia and pain

Question 15

PROS and CONS for Botox injections

Answer 15

Pros - effective for focal spasticity, very low systemic SE, high user satisfaction
Cons - NOT effective for generalized spasticity unless focal goals identified.

Question 16

Indications for baclofen pump

Answer 16

Severe and generalized spasticity
Ease of care and pain control
Recurrent MSK deformities because of the spasticity

Question 17

Contraindications for baclofen pump

Answer 17

Negative response to trial infusion
Hypersensitivity, depression
Small stature, poor trunk control, scoliosis
— patients need to be super screened for this machine

Question 18

What does the baclofen pump do

Answer 18

Bypasses the systemic side effects of oral meds and delivers the baclofen right to the level of the SC
Therapeutic dose is 1/100th the oral dose so way less drowsiness
Great for kiddos GMFCS level 4-5

Question 19

Possible complications of the baclofen pump

Answer 19

Infection and general anesthesia
CSF leakage
Pump malfunctions
Kinking, dislodging, fracturing of catheters
== can lead to death if don’t recognize signs of withdrawal

Question 20

Goals of PT

Answer 20

Promote increased ROM
Strengthen
Increase functional training
ALL as an adjunct to meds that reduce spasticity