Neurostimulation in the Medical Management of Spasticity

**Chapter 4**

**Abstract**

cost of BoNT.

**1. Introduction**

**49**

Spasticity: Diagnosis

*Alexander Kovalenko, Viktor Misikov, Konstantin Sinelnikov,*

This chapter presents the technology of spasticity treatment—from diagnosis and treatment to quality control of treatment and rehabilitation. The diagnosis is based on methods of manual testing and differential diagnosis of spastic muscles, methods of quantitative assessment of spasticity on the basis of the Tardieu scale. The methodical development of the Tardieu scale with variants of its full and reduced use is presented. The basic patterns of spasticity of the upper and lower limbs are given. Schemes of management of patients with spasticity with indication of control points for application of methods of an assessment that shows efficiency of treatment and rehabilitation are presented. The methodology of spasticity treatment using botulinum neurotoxin (BoNT), including ultrasonic navigation, orientation of intramuscular motor endpoint of muscles (IME), is described. IME location diagrams and ultrasound picture of muscles are presented. Scales are proposed to assess the effect of spasticity on the functions of the upper and lower limbs. In conclusion, a variant of complex treatment of spasticity and original patient models are proposed, the use of which makes it possible to calculate the

**Keywords:** spasticity, patterns of spasticity, testing of spastic muscles,

spinal cord lesions, and 85% of patients with multiple sclerosis [4, 5].

ultrasonic navigation, intramuscular motor endpoint (IME), rehabilitation

Spasticity as the most important component of the defeat syndrome of the upper motor neuron is a motor disorder characterized by a speed-dependent increase in tonic stretching reflexes (muscle tone) with increased tendon reflexes, due to hyperexcitability of the stretching reflex, as one of the components of the syndrome [1]. It is detected in more than 12 million people in the world and is the cause of disability in 12–27% of them [2, 3]. The list of nosological forms in which the structure of the injury syndrome in the *upper motor neuron lesion* (UMNL) observed spastic hypertonicity is significant. It is determined in approximately 20–40% of stroke survivors, 14% of traumatic brain injury survivors, 65–78% of patients with

modified Tardieu scale (MTS), botulinum neurotoxin (BoNT),

*Valeriy Shamigulov, Dmitrii Iskra, Svetlana E. Khatkova*

and Treatment

*and Denis V. Kovlen*
