Journal article Open Access

SpasticityManagement in Disorders of Consciousness

Martens, Géraldine; Laureys, Steven; Thibaut, Aurore


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    <subfield code="a">spasticity; pain; upper motor neuron syndrome; disorders of consciousness; brain injury; treatment</subfield>
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    <subfield code="u">Coma Science Group, GIGA Research (Interdisciplinary Cluster for Applied Genoproteomics)–GIGA Consciousness &amp; Neurology Department, University and University Hospital of Liege, 4000 Liege, Belgium</subfield>
    <subfield code="a">Laureys, Steven</subfield>
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    <subfield code="a">Martens, Géraldine</subfield>
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    <subfield code="a">Studying, Measuring and Altering Consciousness through information theory in the electrical brain</subfield>
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    <subfield code="a">&lt;p&gt;Background: Spasticity is a motor disorder frequently encountered after a lesion involving&lt;br&gt;
the central nervous system. It is hypothesized to arise from an anarchic reorganization of the&lt;br&gt;
pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected&lt;br&gt;
muscular groups. While this symptom and its management is well-known in patients suffering from&lt;br&gt;
stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management&lt;br&gt;
in patients presenting disorders of consciousness after brain damage. Objectives: Our aim was to&lt;br&gt;
review the occurrence of spasticity in patients with disorders of consciousness and the therapeutic&lt;br&gt;
interventions used to treat it. Methods: We conducted a systematic review using the PubMed online&lt;br&gt;
database. It returned 157 articles. After applying our inclusion criteria (i.e., studies about patients in&lt;br&gt;
coma, unresponsive wakefulness syndrome or minimally conscious state, with spasticity objectively&lt;br&gt;
reported as a primary or secondary outcome), 18 studies were fully reviewed. Results: The prevalence&lt;br&gt;
of spasticity in patients with disorders of consciousness ranged from 59% to 89%. Current treatment&lt;br&gt;
options include intrathecal baclofen and soft splints. Several treatment options still need further&lt;br&gt;
investigation; including acupuncture, botulin toxin or cortical activation by thalamic stimulation.&lt;br&gt;
Conclusion: The small number of articles available in the current literature highlights that spasticity&lt;br&gt;
is poorly studied in patients with disorders of consciousness although it is one of the most common&lt;br&gt;
motor disorders. While treatments such as intrathecal baclofen and soft splints seem effective,&lt;br&gt;
large randomized controlled trials have to be done and new therapeutic options should be explored.&lt;/p&gt;</subfield>
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