Spasticity: Difference between revisions

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=== Clinic ===
=== Clinic ===
*Spasticity is an entity characterized with excessive velocity-dependent muscle contraction
*Spasticity is an [[Upper motor neuron, UMN|Upper motor Neuron]] / [[Pyramidal system|Pyramidal]] [[entity]]
* It results from the loss of inhibition of UMN, and ends in tightness, stiffness or pull of muscles
*It is characterized with excessive velocity-dependent muscle contraction
* [[UMN, Upper Motor Neuron|UMN disease]] contain Spasticity and [[Clonus]] as two separate entities
*Spasticity is an exaggerated stretch reflex
* Spasticity naturally depends on Muscle speed and range of motion. It manifests itself when the muscle contracts at high speed. This means that when the speed and amplitude of contraction exceeds the threshold, Spasticity occurs
*It is characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex
* It results from the loss of inhibition of [[Upper motor neuron, UMN|UMN]], and ends in tightness, stiffness or pull of muscles
* Spasticity naturally depends on Muscle speed and range of motion.  
* It manifests itself when the muscle contracts at high speed. This means that when the speed and amplitude of contraction exceeds the threshold, Spasticity occurs
* Depends on the location, Spasticity might cause problem in Movement / Speech or Pain
* Depends on the location, Spasticity might cause problem in Movement / Speech or Pain


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*Strength dependent: Increasing the strength of muscle stretch reflex causes the muscle to contract with greater intensity and power in response to stretching, and this contraction has a direct relationship with the strength of stretching. In this condition, spasticity is occurred.
*Strength dependent: Increasing the strength of muscle stretch reflex causes the muscle to contract with greater intensity and power in response to stretching, and this contraction has a direct relationship with the strength of stretching. In this condition, spasticity is occurred.


=== Entity / Miasm ===
=== Entity / Miasm ===
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!GSS
!GSS
!CJD
!CJD
!JE
!NVCJD
!EEE/WEE
!FFI
!HTLV-1
|-
|-
|Paralysis, Spastic
|[[Hyper reflexia]]
| +++
| +++
| +++
| +++
| +++
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| +++
| +++
|-
|-
|Hyper reflexia
|[[Spasm]]
| +++
| +++
| +++
| +++
| +++
|
| +++
| +++
|-
|[[Hypertonia]]
|
|
| +++
| +++
|
|}
|}
Why I do not Spasm as a symptom of Spasticity?
* Spasm is an entity itself
* Pain of Spasticity is not a dynamic symptom, but is a static/ Mechanical symptoms caused by muscular stretching


Note that here hypertonia is used in its general meaning. Its rubric is [[spasm]].
=== Causes ===
=== Causes ===
* It mostly occurs in CNS disorders affecting UMN in the form of a lesion or syndrome
* It mostly occurs in CNS disorders affecting UMN in the form of a lesion or syndrome
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* Combination of decreased inhibition and an increased depolarized state of cell membranes, decreases action potential threshold for nerve signal conduction, and thus increases activity of structures innervated by the affected nerves (spasticity).  
* Combination of decreased inhibition and an increased depolarized state of cell membranes, decreases action potential threshold for nerve signal conduction, and thus increases activity of structures innervated by the affected nerves (spasticity).  
* Muscles affected in this way have many other potential features of altered performance in addition to spasticity, including  
* Muscles affected in this way have many other potential features of altered performance in addition to spasticity, including  
** Muscle ''weakness''
** Muscle weakness
** Decreased movement control
** Decreased movement control
** Clonus  
** [[Clonus]]
** Exaggerated deep tendon reflexes
** Exaggerated deep tendon reflexes
** Decreased endurance
** Decreased endurance
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* [[Parkinson disease]]
* [[Parkinson disease]]
* [[MS, Multiple Sclerosis|MS]]
* [[MS, Multiple Sclerosis|MS]]
* [[CP, Cerebral palsy|CP]]
* [[Cerebral palsy|CP]]

Latest revision as of 08:24, 28 September 2023

Clinic

  • Spasticity is an Upper motor Neuron / Pyramidal entity
  • It is characterized with excessive velocity-dependent muscle contraction
  • Spasticity is an exaggerated stretch reflex
  • It is characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex
  • It results from the loss of inhibition of UMN, and ends in tightness, stiffness or pull of muscles
  • Spasticity naturally depends on Muscle speed and range of motion.
  • It manifests itself when the muscle contracts at high speed. This means that when the speed and amplitude of contraction exceeds the threshold, Spasticity occurs
  • Depends on the location, Spasticity might cause problem in Movement / Speech or Pain


Diagnostic Characters

  • Asymmetric: Because it involves the antagonist muscles
  • Velocity-dependent: It increases tonic stretch reflexes and tendon jerks, resulting from hyper-excitability of the stretch reflex
  • Strength dependent: Increasing the strength of muscle stretch reflex causes the muscle to contract with greater intensity and power in response to stretching, and this contraction has a direct relationship with the strength of stretching. In this condition, spasticity is occurred.


Entity / Miasm

GSS CJD NVCJD FFI
Hyper reflexia +++ +++ +++ +++
Spasm +++ +++ +++
Hypertonia +++

Note that here hypertonia is used in its general meaning. Its rubric is spasm.

Causes

  • It mostly occurs in CNS disorders affecting UMN in the form of a lesion or syndrome
  • It can also be present in various types of multiple sclerosis or neuromuscular cerebral palsy
  • Spastic cerebral palsy is the most common form of CP


Mechanism

  • One factor that is thought to be related to spasticity is the stretch reflex
  • Combination of decreased inhibition and an increased depolarized state of cell membranes, decreases action potential threshold for nerve signal conduction, and thus increases activity of structures innervated by the affected nerves (spasticity).
  • Muscles affected in this way have many other potential features of altered performance in addition to spasticity, including
    • Muscle weakness
    • Decreased movement control
    • Clonus
    • Exaggerated deep tendon reflexes
    • Decreased endurance


Related entities


Related disease

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