[Spasticity: from pathophysiology to treatment]

Neurointerface with oscillator motifs for inhibitory effect over antagonist muscles

The effect of inhibitory management is usually underestimated in artificial control systems, using biological analogy. According to our hypothesis, the muscle hypertonus could be effectively compensated via stimulation by bio-plausible patterns. We proposed an approach for the compensatory stimulation device as implementation of previously presented architecture of the neurointerface, where (1) the neuroport is implemented as a DAC and stimulator, (2) neuroterminal is used for neurosimulation of a set of oscillator motifs on one-board computer. In the set of experiments with five volunteers, we measured the efficacy of motor neuron inhibition via the antagonist muscle or nerve stimulation registering muscle force with and without antagonist stimulation. For the agonist activation, we used both voluntary activity and electrical stimulation. In the case of stimulation of both the agonist and the antagonist muscles and nerves, we experimented with delays between muscle stimulation in the range of 0-20 ms. We registered the subjective discomfort rate. We did not identify any significant difference between the antagonist muscle and nerve stimulation in both voluntary activity and electrical stimulation of cases showing agonist activity. We determined the most effective delay between the stimulation of the agonist and the antagonist muscles and nerves as 10-20 ms.

[Correction of gait stereotype and reduction of the risk of falling in patients with equinovarus foot placement and central hemiparesis]

OBJECTIVE

To test a new approach to gait stereotype correction for patients with central hemiparesis with talipes equinovarus.

MATERIAL AND METHODS

The study was performed in a group of patients with formed talipes equinovarus and post-stroke hemiparesis. Footwear with orthopaedic elements was offered to the patients. Evaluation of spatial and temporal gait parameters was performed and the risk of falls was assessed.

RESULTS

In the process of work, data were obtained confirming the effectiveness of using specialized shoes for equinovarus foot placement. The risk of falling significantly decreased when walking; walking became more symmetrical due to an increase in the anterior extension of the paretic limb.

CONCLUSION

Application of this method does not decrease the tone in the paretic limb but optimises the gait stereotype, facilitates the increases of its velocity and decreases the risk of falling.

[Tardue scales in the diagnostic of spasticity]

Diagnosis, treatment and rehabilitation of patients with spasticity remain a challenge, in which standard methodological approaches have not yet been developed. One of the most promising solutions to this problem is the use of the Modified Tardieu scale (MTS). The article describes the method of working with MTS tested in the examination, treatment and rehabilitation of patients with acute cerebrovascular accident (n=112) and patients with multiple sclerosis (n=17). The original version of MTS has been translated into Russian. The use of MTS assessment system allows the diagnosis of the main elements of the clinical picture of the damage to the central nervous system, such as paresis, spasticity, violation of proprioception, as well as the qualitative and quantitative assessment of the dynamics of rehabilitation and treatment of spasticity with botulinum neurotoxin (BoNT).

[Combination of central and peripheral muscle relaxants in the treatment of post-stroke spasticity]

AIM

To study the electromiographic (EMG) parameters and to evaluate the therapeutic efficacy of a combination of central (baclofen, baclosan) and peripheral (incobotulotoxinA, xeomin) muscle relaxants in the treatment of post-stroke spasticity (PSS).

MATERIAL AND METHODS

Ninety-six patients with PSS of upper and lower limbs were divided into 2 groups: the first group (n=56) was treated with xeomin and the second (n=40) received combined therapy of xeomin and baclofen. Xeomin was administered according to the pattern of spasticity. The total dosage reached 800 U. Baclofen was used orally in a dose of 10 mg 3 times a day. The scales of paresis and spasticity assessment (MRCS, MAS and Tardieu), activity and participation of patients in everyday life (Bartel, Rankin, Rivermead mobility Index, comfortable walking test, LASIS) were used. EMG and transcranial magnetic stimulation (TMS) were performed. M-response, H-reflex, F-wave, central conduction time were determined. The total duration of the study was 120 days. Patients were assessed at 4 points.

RESULTS AND CONCLUSION

Potentiation of peripheral and central muscle relaxants and prolongation of the effect of xeomin was revealed (it was expressed in the reduction of the number of injection sessions from 7-8 to 5-6). The use of xeomin in a total dosage of up to 800 U has shown its efficacy and safety for the treatment of spasticity of the upper and lower limbs. The results of EMG and TMS shed a light on the mechanisms of the therapeutic effect of combined (xeomin+baclosan) and monotherapy (xeomin) spasticity.