Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium.
Departments of Physical Medicine and Rehabilitation, CHU UCL (Université catholique de Louvain) Namur site Godinne, Belgium.
Clin Neurophysiol. 2019 Feb;130(2):207-213. doi: 10.1016/j.clinph.2018.10.021. Epub 2018 Dec 6.
The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in patients with prolonged DOC.
We prospectively enrolled adult patients with DOC at least 3 months post traumatic or non-traumatic brain injury. The spastic profile was investigated using the Modified Ashworth Scale and the Hmax/Mmax ratio. T1 MRI data and impact of medication were analyzed as well.
21 patients were included (mean age: 41 ± 11 years; time since injury: 4 ± 5 years; 9 women; 10 traumatic etiologies). Eighteen patients presented signs of SMO and 11 had an increased ratio. Eight patients presented signs of SMO but no increased ratio. We did not find any significant correlation between the ratio and the MAS score for each limb (all ps > 0.05). The presence of medication was not significantly associated with a reduction in MAS scores or Hmax/Mmax ratios.
In this preliminary study, the Hmax/Mmax ratio does not seem to reflect the clinical MAS scores in patients with DOC. This supports the fact they do not only present spasticity but other forms of SMO and contracture.
Patients with DOC are still in need of optimized tools to evaluate their spastic profile and therapeutic approaches should be adapted accordingly.
严重皮质和皮质下损伤后意识障碍（DOC）患者的痉挛性肌肉过度活动（SMO）的临床和电生理特征记录不佳。我们旨在研究持续性 DOC 患者的 SMO 临床观察与电生理痉挛过度反应之间的联系。
我们前瞻性纳入至少 3 个月创伤性或非创伤性脑损伤后出现 DOC 的成年患者。使用改良 Ashworth 量表和 Hmax/Mmax 比值评估痉挛程度。还分析了 T1 MRI 数据和药物的影响。
共纳入 21 例患者（平均年龄：41±11 岁；伤后时间：4±5 年；9 名女性；10 例创伤性病因）。18 例患者出现 SMO 征象，11 例患者 Hmax/Mmax 比值升高。8 例患者出现 SMO 征象，但 Hmax/Mmax 比值无升高。我们未发现各肢体比值与 MAS 评分之间存在任何显著相关性（所有 p 值均>0.05）。药物的存在与 MAS 评分或 Hmax/Mmax 比值的降低均无显著相关性。
在这项初步研究中，Hmax/Mmax 比值似乎不能反映 DOC 患者的临床 MAS 评分。这支持了这样一个事实，即他们不仅表现出痉挛，还表现出其他形式的 SMO 和挛缩。
DOC 患者仍需要优化的工具来评估他们的痉挛程度，治疗方法也应相应调整。
