CLASSIFICATION OF UPPER LIMB SPASTICITY PATTERNS IN PATIENTS WITH MULTIPLE SCLEROSIS: A PILOT OBSERVATIONAL STUDY

Objective: The aim of this study was to provide a classification of the upper limb patterns in patients with upper limb spasticity due to multiple sclerosis. Design: Pilot observational study. Patients: Twenty-five adult patients with multiple sclerosis suffering from upper limb spasticity who underwent one segmental (i.e., proximal and distal upper limb) botulinum toxin treatment cycle were recruited. Methods: Patients remained in a sitting position during the evaluation. Upper limb spasticity postures (i.e., postural attitude of a single joint/anatomical region) were evaluated and recorded for the shoulder (adducted/internally rotated), elbow (flexed/ extended), forearm (pronated/supinated/neutral), wrist (flexed/extended/neutral) and hand (fingers flexed/thumb in palm). Results: On the basis of the clinical observations, 6 patterns (i.e., sets of limb postures) of upper limb spasticity have been described according to the postures of the shoulder, elbow, forearm, and wrist. Conclusion: The patterns of upper limb spasticity in patients with multiple sclerosis described by this pilot study do not completely overlap with those observed in patients with post-stroke spasticity. This further supports the need to consider the features of spasticity related to its aetiology in order to manage patients appropriately. LAY ABSTRACT This pilot study aimed to describe typical positions of the arm in people with multiple sclerosis suffering from muscle overactivity. We included 25 adults who were treated once with botulinum toxin injection into the arm muscles. After clinical evaluation we defined 6 sets of combined positions (the so-called patterns) involving the shoulder, elbow, forearm, and wrist. These patterns were peculiar to people with multiple sclerosis with only few similarities to individuals with stroke. Outlining the specific presentation in patients with multiple sclerosis will help to provide more appropriate clinical support, such as defining proper injection regimens of botulinum toxin type A, which is a first-line treatment for muscle overactivity.