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Post-stroke spasticity is a painful consequence of a stroke that every year in Poland suffers about 75 thousand. people. Stroke is the third leading cause of death in developed countries and the first leading cause of disability in adults in their 60s.

Spasticity after strokein adults occurs when the muscles do not respond to the signals the brain sends to relax muscles. There is a permanent, painful contraction of the muscle, which prevents movement and normal daily activities, such as dressing, washing, etc. Characteristic for patients with spasticity are: a clenched fist, bent wrist, twisted elbow or arm pressed to the breast.

What is post-stroke spasticity?

Spasticity is a state of increased muscle tension, which contributes to: difficulties in rehabilitation, pain, impeding hygiene and self-service, withdrawal from social and social life, lower self-esteem, deterioration of mood and quality of life.

Every fifth stroke patient suffers from spasticity.

About 20 percent develop spasticity three months after stroke. patients. Untreated spasticity leads to: permanent contractures, joint deformities, bedsores, venous thrombosis, infections, imbalance while walking, limb fractures.

Stroke patients most often suffer from spasticity in the upper limb. The hand with spasticity, i.e. excessive muscle tension, does not respond to the brain's commands as before. The contracted muscles prevent full range of movement and are sometimes painful. Until now mundane activities, such as grabbing and releasing objects, become almost impossible, which changes the lives of sick people a lot.

How to recognizesymptoms of spasticityof the hand? - “Spasticity, which is a consequence of stroke, in most patients develops 3 months after onset, but it should be remembered that it may appear earlier. Quick recognition of the symptoms of spasticity in the upper limb is the way to restore its efficiency - says Prof. dr hab. n. med. Jarosław Sławek, Head of the Department of Neurological and Psychiatric Nursing at the Medical University of Gdańsk. - “The hand affected by spasticity in people after a stroke is characterized by an unnatural position of the limb during rest and during movement attempts.People struggling with post-stroke spasticity also have a problem with grasping and releasing objects.

- “The symptoms of spasticity, although recognizable, are unfortunately often overlooked. As a result, treatments that would restore the hand's ability to function are starting too late. The "Open Your Hand After Stroke" campaign was created to educate and inform patients and their relatives about the symptoms of spasticity and possible forms of treatment, "emphasizes Adam Siger from the Brain Stroke Foundation.

- “Stroke survivors most often struggle with spasticity in the wrist and elbow. In the epidemiological studies published so far, post-stroke spasticity occurs about 10% more often in the upper limb compared to the lower limb. In the event of a stroke, damage occurs at the "high" level of the hemispheres of the brain and the brainstem, which contributes to disturbances in the control of movements of the upper limbs. - explains the drug. med. Michał Schinwelski from the Neurology Department of the Specialist Hospital of St. Wojciech in Gdańsk.

Stroke is a disease of the elderly

The incidence of stroke increases with age, for example: for people aged 45 to 55, the risk of having a stroke is 1 in 1000 per year. Between the ages of 65 and 75 - 1 in 100, and after the age of 85 - 1 in 30. Stroke is when the brain cells die due to insufficient blood supply. When blood flow in the brain is disturbed or interrupted, brain cells do not receive essential nutrients, oxygen and glucose. Blood flow can be disrupted for two reasons: blockage in the carotid or artery in the brain and rupture of a blood vessel that begins to bleed into the brain.

Spasticity - treatment methods

1) Giving medications to reduce the symptoms of spasticity

2) Surgical treatment (cutting the tendons, cutting the dorsal roots or electrostimulation - at the level of the spine, cerebellum and brain)

3) Rehabilitation - kinesiotherapy, physiotherapy, occupational therapy. Rehabilitation after a stroke is very important. It significantly reduces the risk of complications after a stroke, such as, for example, pressure ulcers. It also increases the chances of the patient regaining fitness.

Spasticity treatment with botulinum toxin

In spasticity, drugs can be administered to patients in several ways - orally, intrathecally and intramuscularly. In the latter case, alcohol, phenol or botulinum toxin type A, commonly used in neurology all over the world for 20 years, and in spasticity of the upper limb for 10 years, can be given.

The use of botulinum toxin type A consists intargeted injection of the injured muscle in the upper limb to inhibit the release of acetylcholine, which is necessary for the muscle to relax. It has been proven that the repetition of such therapy significantly improves the he alth condition of patients suffering from local spasticity. without affecting muscles not affected by spasticity. A similar effect is not possible in the case of treatment with oral antispastic drugs- says prof. dr hab. Andrzej Friedman, MD from the Department of Neurology, Medical University of Warsaw.

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Treatment of spasticity with botulinum toxin is reimbursed by the National He alth Fund

Since March 1, 2014, treatment of patients with botulinum toxin in Poland is fully reimbursed by the National He alth Fund under the drug program "Treatment of spasticity of the upper limb with botulinum toxin type A". Information on this subject can be found on the website of the Brain Stroke Foundation, www.fum.info.pl.

-It is important that patients receive botulinum therapy as soon as possible after the onset of spasticity and the onset of the disease. The necessary condition for the treatment is the simultaneous introduction of rehabilitation, aimed at the independence of the patient- says Dr. hab. n. med., prof. extra Jarosław Sławek from the Faculty of He alth Sciences of the Medical University of Gdańsk and the Department of Neurology of the St. Wojciech in Gdańsk.

In the macro scale, the cost of treating patients with spasticity is not high. However, from the point of view of an elderly pensioner, it often becomes an unsustainable cost. The average annual cost of treating a patient is, according to the AOTM recommendation, PLN 1700-1800, the problem concerns about 2000 patients per year, which means an expenditure of about PLN 3.6 million from the state budget.

Where to go for help

People who struggle with spasticity as a result of a stroke can seek help at the Brain Stroke Foundation (www.fum.info.pl). The goal of the Foundation is to work for the benefit of patients and their families suffering from stroke and other neurological diseases, as well as to work for he alth protection and social care. More information about the campaign "Open a hand after a stroke" at www.fum.info.pl, www.fizjoterapeuci.org and www.facebook.com/otworzdlonpoudarza.

The text uses the materials of the Brain Stroke Foundation.

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Neurology