Adult Upper Limb Spasticity Overview

Etiologies

One of the most common causes of upper limb spasticity in adults is a stroke. After a stroke, signals from the brain to the muscles may not work correctly.1 Signs of spasticity may develop within weeks or over a longer period of time.2

Even if you haven’t had a stroke, there are other conditions (listed below) that may cause your brain to send the wrong signals to your muscles and cause adult upper limb spasticity.3,4

  • Other causes of upper limb spasticity in adults include3,4:
    • Traumatic brain injury
    • Multiple sclerosis
    • Spinal cord problems (such as lesions)
    • Cerebral palsy in adults
  • The majority of patients treated for upper limb spasticity with XEOMIN in clinical trials were adults with post-stroke spasticity5-7

Impact of a stroke

  • Nearly 800,000 people suffer strokes in the United States every year8
  • Worldwide numbers are even larger. In 2010, 33 million people suffered a stroke, with 16.9 million first-time strokes8
  • Stroke is the leading cause of adult disability8

Manifestation of spasticity

  • Spasticity may be one of many possible consequences after a stroke
  • There are a wide range prevalence data in post-stroke spasticity from as little as 19% to as much of 92% of patients9
  • The onset of spasticity after stroke is also highly variable. It may occur shortly after the stroke or more than 1 year later.2,9,10
    • 4% to 27% have signs of spasticity within 4 weeks
    • 19 to 27% show initials signs of spasticity between 1 month and 3 months following the stroke
    • 17% to 43% don’t have signs of spasticity until after 3 months

Diagnosis of post-stroke ULS

  • Signs of spasticity may develop within weeks or over a longer period of time11
  • Therefore, spasticity may be underdiagnosed because patients are often released from the stroke unit or ICU before spasticity presents
    • Patients might just accept spasticity as a consequence of their stroke and not proactively mention it during an exam
    • Raising awareness and educating patients while they are in care settings, such as stroke centers, rehab facilities, and nursing homes, may help increase the likelihood of diagnosis and treatment

Symptoms

Adult upper limb spasticity is a clinical problem in which muscles become overactive and tense, leading to difficulty in movement and limits on the ability to perform daily activities.4

Adult patients with upper limb spasticity may experience symptoms including but not limited to4:

  • Muscle stiffness (known as hypertonia)
  • Limited range of movement
  • Reduced ability to relax muscles
  • Muscle spasms
  • Changes in limb position
  • Pain

Symptoms may have an impact on activities of daily living. The severity of symptoms varies among patients from mild to severe.4

Clinical presentation of adult Upper Limb Spasticity

Treatment

  • Botulinum toxin injections are a level-A recommended option for the treatment of post-stroke spasticity of the upper limb—according to the American Academy of Neurology12

References

  1. Recovery after stroke: movement and balance. National Stroke Association website. http://www.stroke.org/stroke-resources/library/movement-and-balance. Accessed October 7, 2015.
  2. Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: a prospective, observational trial. J Neurol. 2010;257(7):1067-1072.
  3. Differential diagnosis for spasticity. NeuroRehab Resource website. http://www.neurorehabresource.org/Files/NRR_Differential_Diagnosis.pdf. Accessed October 7, 2015.
  4. Spasticity. American Association of Neurological Surgeons website. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Spasticity.aspx. Accessed October 7, 2015.
  5. Elovic EP, Munin MC, Kanovsky P, Hanschmann A, Hiersemenzel R, Marciniak C. Randomized, placebo-controlled trial of incobotulinumtoxinA for upper-limb post-stroke spasticity [published online ahead of print]. Muscle Nerve. doi: 10.1002/mus.24776.
  6. Kanovsky P, Slawek J, Denes Z, et al. Efficacy and safety of botulinum neurotoxin NT 201 in poststroke upper limb spasticity. Clin Neuropharmacol. 2009;32(5):259-265.
  7. Barnes M, Schnitzler A, Medeiros L, Aguilar M, Lehnert-Batar A, Minnasch P. Efficacy and safety of NT 201 for upper limb spasticity of various etiologies—a randomized parallel-group study. Acta Neurol Scand. 2010;122(4):295-302.
  8. Data on file. Raleigh, NC: Merz North America, Inc.
  9. Impact of stroke (stroke statistics). American Stroke Association website. http://www.strokeassociation.org/STROKEORG/AboutStroke/Impact-of-Stroke_UCM_310728_Article.jsp#. Accessed December 7, 2015.
  10. Ward AB. A literature review of the pathophysiology and onset of post-stroke spasticity. Eur J Neurol. 2012;19(1):1.
  11. Wissel J, Manack A, Brainin M. Toward an epidemiology of poststroke spasticity. Neurology. 2013;80(3 Suppl 2):1.
  12. Simpson DM, Gracies J-M, Graham HK, et al. Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008;70(19):1691-1698.