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Muscle Spasticity : Baclofen Vs. Botulinum Toxin Type A

Definition

Spasticity is a feature of altered skeletal muscle performance, occurring in disorders of the central nervous system (CNS) which give rise to the Upper Motor Neuron Syndrome. Muscles affected by the Upper Motor Neuron Syndrome have many other potential features of altered performance including weakness, decreased motor control, clonus (a series of involuntary rapid muscle contractions), exaggerated deep tendon reflexes and decreased endurance. The Upper Motor Neuron Syndrome occurs following damage to the central nervous system, when there is a loss of descending inhibition from the brain to the spinal cord, such that muscles become overactive. This loss of inhibitory control can cause an ongoing level of contraction, with decreased ability for the affected individual to volitionally control the muscle contraction, and increased resistance felt on passive stretch. A defining feature of spasticity is that the increased resistance to passive stretch is velocity-dependent, as described in the commonly cited definition of spasticity from Lance (1980): “a motor disorder, characterised by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex as one component of the upper motor neurone (UMN) syndrome”.

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