What is a Stroke/Brain Attack? - National Stroke Association

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What is a Stroke/Brain Attack? - National Stroke Association

Diazepam (Valium®) helps control spasticity by relaxing the muscle. It is not used as

frequently as other spasticity medications due to significant side effects including

reduced mental sharpness, dependency and fatigue. It should only be used in select

circumstances and with close monitoring of its effects.

Nerve Block Injections

Botulinum toxin (Botox®) is injected into the affected muscles to relax their spasticity by

blocking the chemical impulses that cause muscles to contract. While oral medication

affects multiple muscle groups in the body, Botox injections target only the specific

muscles which are injected. A single injection can relax affected muscles for three to six

months before the effects wear off. Side effects include soreness or swelling at the

injection site, fatigue, excess muscle weakness and possible antibody formation.

Botulinum toxin is most effective for managing spasticity in specific limbs or muscle

groups.

Phenol is a type of alcohol which chemically blocks nerves in the affected muscles to

reduce the spasticity. Neither block is suitable for patients with full-body spasticity

because the treatment is technologically difficult. Phenol injections may cause pain

during and after injection.

Spinal Medication

Intrathecal Baclofen (ITB) therapy delivers a liquid form of baclofen directly into the

spinal fluid via a small pump that is surgically placed under the skin. Since the

medication does not circulate throughout the body, only small doses are required to

be effective, reducing the side effects common with oral baclofen. ITB Therapy has

been shown to be effective in people with severe spasticity, including some who have

not had good results with oral medications. The most common ITB Therapy drug side

effects include loose muscles, drowsiness, nausea/vomiting, headache and dizziness.

Orthopedic Surgery

Surgery on specific affected muscles can improve isolated tasks in patients with severe

spasticity. One of the most dramatic surgical procedures to improve the ability to walk

is the split anterior tibial transfer (SPLATT). In a SPLATT operation, the surgeon splits a

tendon that makes the foot turn inward and moves half of the tendon to the outside of

the foot where it can help straighten and balance the foot as a walking surface. Surgery

to cut and transfer tendons is also performed on other problematic muscles.

Neurosurgery

Neurosurgery is reserved as a last resort when other methods, such as nerve blocks,

fail. Nerves can be surgically cut to more permanently disrupt nerve function. In a drastic

surgery called rhizotomy, nerves are severed as they leave or enter the spinal cord,

interrupting the spinal reflex arc and ending spasticity permanently.

Treatment of spasticity in stroke survivors should be customized for the patient taking

into careful consideration the extent of the problems, individual symptoms and the

patient’s personal lifestyle goals. A combination of physical and occupational therapy,

home exercise, medications and injections may be used to achieve the best function

possible.

National Stroke Association’s Complete Guide to Stroke

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