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Defining the spectrum of spasticity-associated involuntary movements.

Abstract

BACKGROUND

Spasticity can be associated with several hyperkinetic involuntary movements generally referred to as "spasms" despite different phenomenology and clinical characteristics.

OBJECTIVE

To better characterize the phenomenology and clinical characteristics of spasticity-associated involuntary movements.

METHODS

We performed a cross-sectional study of a consecutive patient sample from the spasticity clinic. Each patient was interviewed by a movement-disorder neurologist who conducted a standardized movement-disorder survey and a focused exam. Patients with involuntary movements were video-recorded and videos were independently rated by a separate blinded movement-disorder neurologist.

RESULTS

Sixty-one patients were included (54% female, mean age 49.7 ± 13.9 years). Of the entire cohort, 11.5% had spinal, 44.3% had cerebral, and 44.3% had mixed-origin spasticity. Fifty-eight patients (95%) reported one or more involuntary movements: 75% tonic spasms (63% extensor, 58% isometric, 41% flexor/adductor), 52% spontaneous clonus, 34% myoclonus, 33% focal dystonia, and 28% action tremor. One third of the involuntary movements were painful. Only 53% of patients reported that their involuntary movements were much or very-much improved with their current anti-spasticity management. Patients treated with intrathecal baclofen therapy were more likely to report much or very-much improvement compared to patients receiving oral and/or botulinum therapy (P = 0.0061 and 0.0069 respectively).

CONCLUSION

Most spastic patients experience spasticity-associated involuntary movements of variable phenomenology and impact. However, only half of these patients experience significant improvement with the current management strategies. More research is needed to explore better treatment options for spasticity-associated involuntary movements with focus on phenomenology-specific approaches.

Authors+Show Affiliations

Multiple Sclerosis and Neuroimmunology Program, Parkinson's disease and Movement Disorder Center, University Hospitals of Cleveland, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address: Hesham.abboud@uhhospitals.org.The Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.Case Western Reserve University School of Medicine, Cleveland, OH, USA.Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.The Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31109729

Citation

Abboud, Hesham, et al. "Defining the Spectrum of Spasticity-associated Involuntary Movements." Parkinsonism & Related Disorders, 2019.
Abboud H, Macaron G, Yu XX, et al. Defining the spectrum of spasticity-associated involuntary movements. Parkinsonism Relat Disord. 2019.
Abboud, H., Macaron, G., Yu, X. X., Knusel, K., Fernandez, H. H., & Bethoux, F. (2019). Defining the spectrum of spasticity-associated involuntary movements. Parkinsonism & Related Disorders, doi:10.1016/j.parkreldis.2019.05.007.
Abboud H, et al. Defining the Spectrum of Spasticity-associated Involuntary Movements. Parkinsonism Relat Disord. 2019 May 12; PubMed PMID: 31109729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining the spectrum of spasticity-associated involuntary movements. AU - Abboud,Hesham, AU - Macaron,Gabrielle, AU - Yu,Xin Xin, AU - Knusel,Konrad, AU - Fernandez,Hubert H, AU - Bethoux,François, Y1 - 2019/05/12/ PY - 2019/02/23/received PY - 2019/05/02/revised PY - 2019/05/03/accepted PY - 2019/5/22/pubmed PY - 2019/5/22/medline PY - 2019/5/22/entrez KW - Clonus KW - Dystonia KW - Movement disorders KW - Spasticity KW - Tonic spasms JF - Parkinsonism & related disorders JO - Parkinsonism Relat. Disord. N2 - BACKGROUND: Spasticity can be associated with several hyperkinetic involuntary movements generally referred to as "spasms" despite different phenomenology and clinical characteristics. OBJECTIVE: To better characterize the phenomenology and clinical characteristics of spasticity-associated involuntary movements. METHODS: We performed a cross-sectional study of a consecutive patient sample from the spasticity clinic. Each patient was interviewed by a movement-disorder neurologist who conducted a standardized movement-disorder survey and a focused exam. Patients with involuntary movements were video-recorded and videos were independently rated by a separate blinded movement-disorder neurologist. RESULTS: Sixty-one patients were included (54% female, mean age 49.7 ± 13.9 years). Of the entire cohort, 11.5% had spinal, 44.3% had cerebral, and 44.3% had mixed-origin spasticity. Fifty-eight patients (95%) reported one or more involuntary movements: 75% tonic spasms (63% extensor, 58% isometric, 41% flexor/adductor), 52% spontaneous clonus, 34% myoclonus, 33% focal dystonia, and 28% action tremor. One third of the involuntary movements were painful. Only 53% of patients reported that their involuntary movements were much or very-much improved with their current anti-spasticity management. Patients treated with intrathecal baclofen therapy were more likely to report much or very-much improvement compared to patients receiving oral and/or botulinum therapy (P = 0.0061 and 0.0069 respectively). CONCLUSION: Most spastic patients experience spasticity-associated involuntary movements of variable phenomenology and impact. However, only half of these patients experience significant improvement with the current management strategies. More research is needed to explore better treatment options for spasticity-associated involuntary movements with focus on phenomenology-specific approaches. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/31109729/Defining_the_spectrum_of_spasticity-associated_involuntary_movements L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(19)30228-7 DB - PRIME DP - Unbound Medicine ER -