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Defining spasticity: a new approach considering current movement disorders terminology and botulinum toxin therapy

Abstract

Spasticity is a symptom occurring in many neurological conditions including stroke, multiple sclerosis, hypoxic brain damage, traumatic brain injury, tumours and heredodegenerative diseases. It affects large numbers of patients and may cause major disability. So far, spasticity has merely been described as part of the upper motor neurone syndrome or defined in a narrowed neurophysiological sense. This consensus organised by IAB—Interdisciplinary Working Group Movement Disorders wants to provide a brief and practical new definition of spasticity—for the first time—based on its various forms of muscle hyperactivity as described in the current movement disorders terminology. We propose the following new definition system: Spasticity describes involuntary muscle hyperactivity in the presence of central paresis. The involuntary muscle hyperactivity can consist of various forms of muscle hyperactivity: spasticity sensu strictu describes involuntary muscle hyperactivity triggered by rapid passive joint movements, rigidity involuntary muscle hyperactivity triggered by slow passive joint movements, dystonia spontaneous involuntary muscle hyperactivity and spasms complex involuntary movements usually triggered by sensory or acoustic stimuli. Spasticity can be described by a documentation system grouped along clinical picture (axis 1), aetiology (axis 2), localisation (axis 3) and additional central nervous system deficits (axis 4). Our new definition allows distinction of spasticity components accessible to BT therapy and those inaccessible. The documentation sheet presented provides essential information for planning of BT therapy.

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Correspondence to Dirk Dressler.

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Conflicts of interest

Dressler D: DD received honoraria for services provided to Allergan, Ipsen, Merz, Desitin, Syntaxin, Abbvie, Medtronic, St Jude, Boston Scientific, Almirall, Bayer, Sun, Teva, UCB, IAB-Interdisciplinary Working Group for Movement Disorders. He is shareholder of Allergan and holds patents on botulinum toxin and botulinum toxin therapy. Bhidayasiri R: No conflict of interest to report. Stock Ownership in medically related fields: None. Consultancies: Ipsen Pharmaceuticals. Advisory Boards: Britannia Pharmaceuticals. Honoraria to speak: Novartis, BL Hua, Abbott. Partnerships: None. Grants: Newton Fund UK, Thailand research fund, Ratchadapisek sompot faculty grant and CU-CLUSTER fund of Chulalongkorn University. Intellectual Property Rights: Parkinson’s disease laser cane, Tremor analysis algorithm, Nocturnal monitoring device (NIGHT-Recorder). Expert Testimony: None. Employment: Chulalongkorn University. Royalties: Blackwell-Wiley, Humana Publications. Others: None. Bohlega S: Nothing to declare. Chana P: Nothing to declare. Chien S: Nothing to declare. Chung TM: Honoraria from Ipsen, Allergan and Merz to lecture in Symposium, Training Couses and Advisory Board participation. Participation in clinical research from Ipsen. No research funding and no financial interest in Botulinum Toxin. Colosimo C: Consultancies with Zambon, Sunovion, Ipsen and Bial. Royalties from Cambridge University Press and Oxford University Press. Ebke M: Nothing to declare. Fedoroff K: Nothing to declare. Frank B: Nothing to declare. Kaji R: Nothing to declare. Kanovsky P: Nothing to declare. Kocer S: Nothing to declare. Micheli F: Nothing to declare. Orlova O: OO is scientific consultant for Ipsen, Allergan, Merz and Microgen. PausS: SP received research grants and lecturer fees from Ipsen Pharma and Merz Pharmaceuticals. Member of the Advisory Boards of Ipsen Pharma and Merz Pharmaceuticals. Pirtosek Z: Nothing to declare. Relja M: Northing to declare. Rosales RL: RR received advisory, research and travel grants from Ipsen Pharma and lecture and travel grants from Allergan and Merz Pharma. Sagastequi A: AS received honoraria for lecturing from Allergan and Ipsen. Schoenle PW: Nothing to declare. Shahidi G: Nothing to declare. Timerbaeva S: Nothing to declare. Walter U: UW received speaker honoraria and travel reimbursement from Merz Pharma, Ipsen Pharma, Allergan, Bristol-Myers Squibb, Daiichi Sankyo, Bayer Vital and Pfizer, and a research grant from Merz Pharma. Adib Saberi F: FAS received reimbursement from Abbot, Abbvie, Almirall, Allergan, Bayer, Desitin, Dynamed, Hempel GesundheitsPartner, Ipsen, Johnson & Johnson, Licher, Meda, Medtronic, Merz, Orion, PTZ Nawrath, Sensomotorik & Rehabilitation Hellmuth & Thiel, Sintetica, Sporlastic, Sun, Teva, Tricumed, TRS Med, UCB.

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All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Dressler, D., Bhidayasiri, R., Bohlega, S. et al. Defining spasticity: a new approach considering current movement disorders terminology and botulinum toxin therapy. J Neurol 265, 856–862 (2018). https://doi.org/10.1007/s00415-018-8759-1

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Keywords

  • Spasticity
  • Rigidity
  • Dystonia
  • Spasms
  • Contractures
  • Treatment
  • Botulinum toxin therapy