How does spasticity affect patients with disorders of consciousness?

Abstract

Spasticity is a frequent issue encountered by brain-damaged patients, arising from an anarchic reorganization of the central nervous system that may significantly alter motor function. While it is well described in patients with a lesion of the descending corticospinal system, little is known about the occurrence and physiopathology of this disorder in patients with more complex brain lesions and disorders of consciousness (coma, unresponsive wakefulness syndrome, and minimally conscious state). Most of the time, these patients are bedridden and lack voluntary motor command which favors spasticity to occur and may lead to complications including pain, loss in range of motion, or bed sores. Given the inability for many of these patients to express their pain or discomfort and knowing that spastic syndromes may restrain them to express signs of consciousness, the multimodal treatment of this spasticity is crucial for their management. In the present chapter, we describe the physiopathology and the current available treatments of spasticity in this specific population of severe brain-injured patients with disorders of consciousness.