Comparative Study of Centrally Acting Muscle Relaxants in Spasticity Associated with Post-Stroke, Cerebral Palsy & Spinal Cord Injury

Abstract

Spasticity is a clinical sign of upper motor neuron dysfunction. It occurs due to defects in inhibitory descending spinal motor pathways. The aim of the treatment of spasticity is to facilitate rehabilitation, increase daily activities, prevent contractures and relieve pain. Nowadays, physiotherapy is becoming a very common practice in the rehabilitative management of spasticity. Stretching can increase the extensibility of soft tissues by a mechanism that involves viscous deformation and structural adaptations of muscle and other soft tissues. Oral baclofen is one of the most common drug used for the treatment of spasticity on a long term basis. It has been reported that baclofen causes reduction in hyperreflexia, muscle tone and contractions of paralyzed muscles. The muscle activity reductions though suggest induction of long-term disuse effects in muscle by baclofen. Infact, it has been reported that patients with SCI or multiple sclerosis have complaints of muscle weakness and reduced voluntary functions after few weeks. In the past two decades, BTX-A has been introduced with an aim to reduce spasticity in children with CP. The benefits of BTX-A treatment include a reduction in muscle tone, increased joint ROM, improved gait patterns, and functional improvements. There is a known association between the use of BTXA and muscle weakness, with reports of generalised muscle weakness and weakness in neighbouring non-targeted muscles. From last few years, tolperisone has presented itself as a very effective and safe muscle relaxant in all types of spasticities. Tolperisone has different pharmacological properties than other myotonolytic agents viz. absence of sedation or withdrawal phenomenon. Only few studies are available evaluating the safety and efficacy profile of tolperisone in post-stroke spasticity and no reports are available for SCI and CP related spasticity.