Pathophysiology of spastic paresis. The hypothesis of «incomplete movement»

Abstract

The structural analysis of modern views on the physiology of spasticity is presented. Based on the well-known provisions on the physiology of movement and the pathophysiology of damage to the upper (first, central) motor neurons, a hypothesis is developed for the development of spasticity as an «incomplete movement», its individual provisions are formulated. In the context of the stated hypothesis, explanations are given to some clinical phenomena and the definition of spasticity is formulated. An explanation of the variability of the patterns of spasticity is proposed both within the framework of one pathology and with various nosological forms. The main strategies in the treatment and rehabilitation of the syndrome of damage to the upper motor neurons are formulated and their physiological justification is given. From a new point of view, the effectiveness of some rehabilitation techniques (therapeutic styling, taping, early use of physiotherapy exercises, creating a comfortable environment, etc.) has been comprehended. Particular attention is paid to the effects of the administration and pharmacodynamics of type A botulinum neurotoxin preparations. A pathophysiological rationale for the reciprocating positive dynamics in the treatment of spasticity with botulinum toxin drugs is proposed as part of the overall rehabilitation process, which gives grounds to consider botulinum neurotoxin injections as an essential element of rehabilitation programs. The proposed hypothesis of «incomplete movement» allows to take a fresh look at the pathophysiology of spasticity, its clinical manifestations and answer many questions. Nevertheless, it requires critical consideration and the formation of an evidence base to confirm the hypothesis.