Focal spasticity therapy : Effects on motor function, health related quality of life, and central nervous system plasticity

Abstract: The overall aim of the thesis was to obtain knowledge about the effects of a comprehensive spasticity management from several perspectives. To achieve this goal, we investigated the effects on motor functions, health-related quality of life, and the central nervous system correlates to a motor task. Already from the beginning in 1999 we adhered to a strict strategy for focal spasticity therapy with careful patient selection and additional therapeutic interventions. In all 141 patients (study I, II, IV) we found an overall improvement in motor functions in 88-90% of patients therapeutic targets. Spasticty improved 1.1-1.2 on the Ashworth Scale. Quality of life (study II, n=41) improved in three of the eight SF-36 health scales, of which two were related to daily physical activities. However, the most significant improvement was found in the dimension of social functioning, which has a strong correlation to a mental dimension and a moderate correlation to a physical. Study III performed in healthy individuals, showed the CNS correlate to a right hand motor task within the primary and secondary motor cortices, supplementary motor cortex, and cerebellum. The regional extent and magnitude of BOLD activities varied moderately between sessions. In Study IV we observed that the patients had recruited larger areas within the right (healthy) hemisphere. Compared to the healthy subjects the brain activity remained more intense (higher BOLD activity) and extensive (more voxels), suggesting increased neuronal activation, increased energy consumption and blood flow during motor performance even after treatment. However, following the comprehensive focal spasticity management there was brain reorganization in a normalising direction in addition to improved motor function.