Dominic Stone
Hypertonia is a condition characterised by abnormally increased muscle tone, causing stiffness and difficulty in movement. It is caused by a communication error in the nervous system, which results in tight and rigid muscles. This can be due to a variety of factors, such as trauma, stroke, reduced oxygen during birth, or other injuries. The treatment for hypertonic muscles depends on the patient's pathology and functionality and can include physical therapy, oral medications, intramuscular injections, and in some cases, surgical procedures. Muscle relaxants, such as Baclofen, Dantrolene, or Diazepam, are often used to reduce symptoms and improve the range of motion. Localised injections, such as botulinum toxin (Botox), can also help to temporarily decrease symptoms by blocking nerve signals in certain areas.
| Characteristics | Values |
|---|---|
| Definition | Abnormally increased muscle tone |
| Cause | Upper motor neuron pathology in the brain or spinal cord |
| Cause | Communication error in the nervous system |
| Cause | Trauma at birth, stroke, brain tumours, toxins that affect the brain, neurodegenerative processes, neurodevelopmental abnormalities |
| Symptoms | Stiff and rigid muscles, difficulty moving arms or legs |
| Symptoms | Frozen joints |
| Treatments | Muscle relaxants such as Baclofen, Dantrolene, or Diazepam |
| Treatments | Localised injections like botulinum toxin (Botox) |
| Treatments | Physical therapy |
| Treatments | Orthopaedic surgery |
| Treatments | Exercise and patient education |
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What You'll Learn
Muscle relaxants such as Baclofen, Dantrolene, or Diazepam
Muscle relaxants are often used to treat hypertonic muscles. Some common muscle relaxants include Baclofen, Dantrolene, and Diazepam.
Baclofen is a medication that comes in tablet form and works by relaxing your muscles, thereby reducing muscle stiffness and spasms. It belongs to a group of medications called muscle relaxants. It is typically taken orally and by mouth. If you miss a dose, it is recommended to take it as soon as possible, but if it is almost time for your next dose, you should skip the missed dose and continue with your regular dosing schedule. It is important not to take a double dose to make up for a missed one. Additionally, it is advised to inform your healthcare provider of any other medications, herbs, or supplements you are taking to prevent potential interactions. Some side effects to look out for include allergic reactions, CNS depression, and drowsiness.
Dantrolene, specifically dantrolene sodium, is a postsynaptic muscle relaxant used in anesthesiology and neurology. Its primary indication for use is the treatment of malignant hyperthermia, a rare but life-threatening disorder triggered by general anesthesia. Dantrolene is available as an intravenous injection and an oral capsule, with the method of administration depending on the intended use. It works by decreasing the amount of calcium within each sarcomere, preventing the actin and myosin cross-bridging, and ultimately reducing the contractibility of the muscle cells.
Diazepam is another medication used to treat muscle spasms, among other conditions such as anxiety and seizures. It is available under various brand names, including Diazemuls and Stesolid Rectal Tubes.
Please note that this information is not a substitute for medical advice, and it is important to consult with a healthcare professional for personalized recommendations and treatment plans.
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Localised injections like botulinum toxin (Botox)
Botox is injected directly into the affected muscle group. The number of injections depends on the size of the muscle and the total number of muscles being injected. The procedure takes just a few minutes, and patients can return to normal activities afterward.
Botox is especially useful for treating cerebral palsy patients, who often experience spasticity, or muscle stiffness. Spastic muscles are tight and make all movement difficult. Botox can help improve motor function and decrease painful muscle spasms.
The effects of Botox typically last between three and six months. Patients begin to notice a gradual fading of its effects after three months, at which point another treatment can be administered. Side effects are generally mild and well-tolerated, with the most common being temporary weakness in the injected area.
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Physical therapy
There are a variety of physical therapy exercises that can be performed to treat hypertonic muscles. These include gentle rocking, where the patient lays on their tummy or back over a therapy ball and rolls forward and backward or side to side. Side-stepping is another exercise that can help, where the patient shifts their weight from one leg to the other before taking a step. Deep pressure to the trunk, shoulders, or legs can also provide additional proprioceptive and sensory input. For children, this can be achieved by giving them deep, gentle squeezes. Heavy work exercises, such as pushing or pulling a weighted laundry basket, can also be beneficial. Bridge exercises, where the patient lays on their back with bent knees and pushes their hips up towards the ceiling, can also help improve hypertonic muscle function.
For infants and children with hypertonic muscles, it is important to position them where they are most comfortable and move the affected body part slowly and safely through their available range of motion. It is important to stop just before the body's natural stop point and hold that range for a few seconds before gently returning to the starting position and repeating. This can help increase the child's range of motion and allow their body to relax. Additionally, a child's pose position, where the child sits on their heels and brings their trunk to their thighs, may be beneficial in preventing increases in tone if the child typically postures in a global extension pattern.
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Oral medications
Hypertonia, or spasticity, is a condition caused by upper motor neuron lesions that may result from injury, disease, or conditions that involve damage to the central nervous system. The condition is characterised by an abnormal increase in muscle tone, resulting in stiff and difficult-to-move arms and legs. Oral medications are often used to treat hypertonia, in conjunction with physical therapy and exercise.
There are several oral medications that can be prescribed to reduce spasticity and relax muscles. These include baclofen, diazepam, and dantrolene. Baclofen can also be injected directly into the cerebrospinal fluid through an implanted pump, known as intrathecal baclofen (ITB) therapy. This method delivers a steady dose of the medication directly to the spinal fluid, resulting in a significant reduction in spasticity and pain, with a lower risk of drowsiness compared to taking baclofen orally.
Diazepam is another effective oral medication for treating hypertonia. It is often considered for short-term treatment and can be paired with therapy to improve short-term motor function. Benzodiazepines, such as diazepam and lorazepam, are also used to manage hypertonia. These medications work by enhancing muscle function and improving the range of motion in hypertonic muscles.
In addition to these muscle relaxants, drugs that affect the dopamine system, such as levodopa/carbidopa or entacapone, are often used to treat rigidity associated with Parkinson's disease, which can be a symptom of hypertonia. It is important to note that oral medications for hypertonia may cause side effects such as drowsiness and weakness. Therefore, a conservative approach is usually undertaken, especially in children, due to the potential for cognitive side effects.
While oral medications can be effective in managing hypertonia, they may not be suitable for everyone. The treatment for hypertonia should be individualised, taking into account the patient's goals, the severity of the condition, and the underlying cause. In some cases, botulinum toxin injections, phenol injections, or surgical procedures may be recommended in addition to or instead of oral medications.
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Surgical procedures
Intrathecal Baclofen (ITB) Therapy
This treatment involves the surgical placement of a pump in the abdomen. The pump releases a steady dose of the medication baclofen directly into the spinal fluid through a connected catheter. This method can significantly reduce spasticity and pain while lowering the risk of drowsiness compared to oral baclofen intake. Baclofen is generally the preferred drug for spinal cord-related spasticity.
Selective Dorsal Rhizotomy (SDR)
SDR is a surgical procedure that addresses spasticity caused by an imbalance in electrical signals to certain muscles. It involves carefully cutting selected nerve roots to rebalance the electrical signals sent to the spinal cord.
Subarachnoidal Application of Phenol
This technique was used to suppress hypertonus of central origin.
Low-Frequency Electrostimulation
Low-frequency electrostimulation, according to Hufschmidt's system, was found to have positive effects on Parkinsonian rigidity and akinesia.
Intramuscular Injections of Lignocaine
Prolonged intramuscular injections of Lignocaine have been shown to have a beneficial effect on dystrophic myotony and stiff-man syndrome, which involves stiffness in the limbs and issues with swallowing and mastication.
Carbamazepine
Carbamazepine has been observed to have a clear positive effect on neuromyotonic patients, reducing spontaneous electromyographic activity and stiffening.
While surgery can be an option in severe cases, it is important to note that non-surgical treatments, such as physical therapy, medication, and botulinum toxin injections, are typically considered first for managing hypertonic muscles.
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