SpasticityManagement in Disorders of Consciousness

Background: Spasticity is a motor disorder frequently encountered after a lesion involving
the central nervous system. It is hypothesized to arise from an anarchic reorganization of the
pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected
muscular groups. While this symptom and its management is well-known in patients suffering from
stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management
in patients presenting disorders of consciousness after brain damage. Objectives: Our aim was to
review the occurrence of spasticity in patients with disorders of consciousness and the therapeutic
interventions used to treat it. Methods: We conducted a systematic review using the PubMed online
database. It returned 157 articles. After applying our inclusion criteria (i.e., studies about patients in
coma, unresponsive wakefulness syndrome or minimally conscious state, with spasticity objectively
reported as a primary or secondary outcome), 18 studies were fully reviewed. Results: The prevalence
of spasticity in patients with disorders of consciousness ranged from 59% to 89%. Current treatment
options include intrathecal baclofen and soft splints. Several treatment options still need further
investigation; including acupuncture, botulin toxin or cortical activation by thalamic stimulation.
Conclusion: The small number of articles available in the current literature highlights that spasticity
is poorly studied in patients with disorders of consciousness although it is one of the most common
motor disorders. While treatments such as intrathecal baclofen and soft splints seem effective,
large randomized controlled trials have to be done and new therapeutic options should be explored.