Mitelman I. Clinical and paraclinical characteristics of post-stroke spasticity and pharmacological methods of its correction.

This dissertation is devoted to the peculiarities of pathogenesis of post-stroke spasticity, particulary to the role of excitatory and inhibitory neuro amino acids, the activity of spinal motor neurons, and detemination of some clinical and para-clinical risk factors of post-stroke spasticity development. Using discriminant analysis had helped to develope a model predicting the risk of spasticity development after first-ever ischemic stroke, was conducted a comparative study of the efficiency of tizanidine in combination with rehabilitation, tolperisone in combination with rehabilitation and rehabilitation as a monotherapy for reduction of post-stroke spasticity. According to a comprehensive survey of 97 patients in the most acute, acute and early recovery period of ischemic stroke was found that the clinical course of acute period was not accompanied by the identification spasticity, while the incidence of post-stroke spasticity at the end of early recovery period (during the sixth month) amounted to 49.5%. The difference in ulnar nerve F-wave's neurofunctional parameters between the two groups of patients (with spasticity and without it), is found in the most acute period of ischemic stroke and rooted in that patients who have post-stroke spasticity, characterized by higher levels of spinal motor neurons activity. Comparative analysis of neuro amino acid's plasma levels of patients with spasticity and without it showed significantly elevated levels of neurotransmitters in all patients with spasticity (compared to the control group). At the same time in patients without spasticity we observed increased concentrations only of aspartate, asparagine, tyrosine and lower concentration of glycine compared to control group. A simple prospective comparative clinical study found that the combination of tolperisone or tizanidine along with rehabilitation has better effect on reducing spasticity than just rehabilitation; tolperisone compared to tizanidine has better effect on reducing of the increased stretch reflex in patients with post-stroke spasticity; if there is pain associated with muscle spasticity tizanidine has shown better analgesic effect.