Spastisite: Fizyopatolojiden Kliniğe

Abstract

Spastisite üst motor nöron lezyonuna bağlı olarak gelişen bir hareket hastalığıdır. Hıza bağlı kas tonusundaki artış olup hastanın günlük aktivitesini etkiler. Beyin ve beyin sapı lezyonlarına bağlı olarak gelişen sık nörolojik sorunlardan birisidir. Fakat spastisite klinik nörolojide en iyi bilinen motor bozukluluklardan birisi olmasına rağmen gerek tanımlanmasında, değerlendirilmesinde ve gerekse de ölçülmesinde sorunlar yaşanmaktadır

Keywords

• Spastisite, Gerim refleksi, Ashworth skalası

Spasticity: From Pathophysiology to Clinical Practice

Abstract

Spasticity is a movement disorder developing after an upper motor neuron lesion. It consists of velocityrelated muscle tonus increase and thus it affects the daily lives of the patients. Spasticity is quite a common disorder and can develop due to various kinds of lesions in the brain and spinal cord. Although spasticity is a well-known clinical entity, its definition, assessment and measurement create challenges for researchers in this field

Keywords

• Spasticity, Stretch reflex, Ashworth scale

References

1. Malhotra S, Pandyan AD, Day CR, Jones PW, Hermens H. Spasticity, an impairment that is poorly defined and poorly measured. Clin Rehabil 2009;23:651-8.
2. Fleuren JF, Voerman GE, Erren-Wolters CV, et al. Stop using the Ashworth Scale for the assessment of spasticity. J Neurol Neurosurg Psychiatry 2010;81:46-52.
3. Lance JW. Spasticity: Disordered Control. Chicago: Yearbook Medical, 1980.
4. Lance JW. What is spasticity? Lancet 1990;335:606.
5. Wartenberg R. Pendulousness of the legs as a diagnostic test. Neurology 1951;1:18-24.
6. Tardieu G, Shentoub S, Delarue R. Research on a technic for measurement of spasticity. Rev Neurol (Paris) 1954;91:143- 4.
7. Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy. European Journal of Neurology 1999;6:S23-S35.
8. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67:206-7.

9. Nielsen JB, Crone C, Hultborn H. The spinal pathophysiology of spasticity--from a basic science point of view. Acta Physiol (Oxf) 2007;189:171-80.
10. Voerman GE, Gregoric M, Hermens HJ. Neurophysiological methods for the assessment of spasticity: The Hoffmann reflex, the tendon reflex, and the stretch reflex. Disabil Rehabil 2005;27:33-68.
11. Boyraz I, Oktay F, Celik C, Akyuz M, Uysal H. Effect of cold application and tizanidine on clonus: Clinical and electrophysiological assessment. J Spinal Cord Med 2009;32:132-9.
12. Delwaide PJ, Pennisi G. Tizanidine and electrophysiologic analysis of spinal control mechanisms in humans with spasticity. Neurology 1994;44:S21-7; discussion S7-8.
13. Pierrot-Deseilligny E, Burke, D. The Circuitry of the Human Spinal Cord, Spinal and corticospinal Mechanisms of Movement. Cambridge: Cambridge University Press, 2012.
14. Biering-Sorensen F, Nielsen JB, Klinge K. Spasticity- assessment: A review. Spinal Cord 2006;44:708-22.
15. Milanov I. Clinical and neurophysiological correlations of spasticity. Funct Neurol 1999;14:193-201.
16. Sherwood AM, Graves DE, Priebe MM. Altered motor control and spasticity after spinal cord injury: Subjective and objective assessment. J Rehabil Res Dev 2000;37:41-52.
17. Aymard C, Katz R, Lafitte C, et al. Presynaptic inhibition and homosynaptic depression: A comparison between lower and upper limbs in normal human subjects and patients with hemiplegia. Brain 2000;123:1688-702.
18. Grey MJ, Klinge K, Crone C, et al. Post-activation depression of soleus stretch reflexes in healthy and spastic humans. Exp Brain Res 2008;185:189-97.
19. Marque P, Simonetta-Moreau M, Maupas E, Roques CF. Facilitation of transmission in heteronymous group II pathways in spastic hemiplegic patients. J Neurol Neurosurg Psychiatry 2001;70:36-42.
20. Maupas E, Marque P, Roques CF, Simonetta-Moreau M. Modulation of the transmission in group II heteronymous pathways by tizanidine in spastic hemiplegic patients. J Neurol Neurosurg Psychiatry 2004;75:130-5.
21. Murray KC, Nakae A, Stephens MJ, et al. Recovery of motoneuron and locomotor function after spinal cord injury depends on constitutive activity in 5-HT2C receptors. Nat Med 2010;16:694-700.
22. Gorassini MA, Knash ME, Harvey PJ, Bennett DJ, Yang JF. Role of motoneurons in the generation of muscle spasms after spinal cord injury. Brain 2004;127:2247-58.
23. Nickolls P, Collins DF, Gorman RB, Burke D, Gandevia SC. Forces consistent with plateau-like behaviour of spinal neurons evoked in patients with spinal cord injuries. Brain 2004;127:660-70.
24. Dietz V. Spastic movement disorder: What is the impact of research on clinical practice? J Neurol Neurosurg Psychiatry 2003;74:820-1.
25. Katz R. Impaired efficacy of spinal presynaptic mechanisms in spastic stroke patients. Brain 2009;132:734-48.