Hereditary Spastic Paraplegia Treatment & Management

Updated: Jan 14, 2019
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Treatment

Approach Considerations

Currently, no specific treatment exists to prevent, retard, or reverse progressive disability in patients with hereditary spastic paraplegia (HSP). Nonetheless, treatment approaches used for chronic paraplegia from other causes are useful.

Moreover, a double-blind, randomized, crossover, sham-controlled study by Ardolino et al indicated that anodal transcutaneous spinal direct current stimulation (tsDCS) can significantly reduce spasticity in HSP. In comparison with the sham group, the anodal patients demonstrated improvement in the Ashworth Scale score, with the benefits still manifesting at 2-month follow-up. The investigators suggested that anodal tsDCS may offer a useful complementary spasticity treatment in HSP. [36]

Regular physical therapy (PT) is important for maintaining and improving range of motion (ROM) and muscle strength, as well as for maintaining aerobic conditioning of the cardiovascular system.

Consultations in HSP can include a physical medicine and rehabilitation specialist and a neurologist.

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Physical Therapy

As stated previously, regular PT is important for maintaining and improving ROM and muscle strength. Furthermore, PT is necessary to maintain aerobic conditioning of the cardiovascular system. Although PT does not reduce the degenerative process within the spinal cord, individuals with HSP must maintain an exercise regimen performed at least several times each week, as guided by their physical therapist.

Exercise can help the patient to retain or improve muscle strength, minimize atrophy of the muscles caused by disuse, increase endurance, reduce fatigue, prevent spasms and cramps, and maintain or improve ROM. Exercise also has a positive psychological effect, helping to reduce stress and produce feelings of well-being.

Patients with HSP may experience spasticity and weakness (ie, increased muscle tone and reduced muscle strength). Because of the increased resistance to passive stretching, spasticity may make it difficult for patients to exercise certain muscles. Antispasmodic drugs may help the patient to reduce the spasticity and may allow weakened muscles to be targeted in order to improve the effectiveness of PT.

Types of exercises

The types of exercise incorporated into PT programs for patients with HSP may include strengthening, stretching, and aerobic exercises.

Strengthening exercises help to strengthen muscles that have not yet weakened. Strengthened muscles help to compensate for muscles that have weakened, decreasing the rate of functional impairment. Exercise may also help to slow the development of disuse atrophy, which occurs in muscles that are not being used (eg, in calf muscles of people who use wheelchairs). Back-strengthening exercises may help to reduce or eliminate back pain associated with HSP. Such pain is probably not due to HSP itself but to strain on the back resulting from HSP (eg, poor gait, poor posture, use of a mobility device).

Stretching exercises help to maintain or increase ROM and to reduce such problems as tendinitis, bursitis, and muscle cramps.

Aerobic exercises improve cardiovascular fitness, reduce fatigue, and increase endurance and general fitness. Walking, bicycle riding, water aerobics, and swimming are among many excellent forms of aerobic exercise.

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