Muscle Relaxant

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Description

Muscle relaxant, also known as muscle relaxer, is a type of medication which reduced function of skeletal muscle function. It is commonly seen in rehabilitation setting actions as management for increased tone or spasticity. In some cases, It is used for children with cerebral palsy (CP) in combination of exercises.[1] Application of muscle relaxant can also be found in population suffering from stroke.[2]

Sometimes, muscle relaxant can also be prescribed as an adjunct to management of musculoskeletal pain, headache, fibromyalgia and myofascial pain syndrome.[3]

Therapeutic Groups

Muscle relaxant can be divided into two major groups: Neuromuscular blockers and spasmolytics

Neuromuscular blocker: This type of muscle relaxants effects peripherally at the neuromuscular end plate. It interferes with transmission between the neurone and muscle fibre to reduce functions of skeletal muscles. It is more commonly seen during surgical procedures, intensive care unit and medical emergency.

Spasmolytics: also know as antispasmodics. It is more commonly seen in the treating community of physiotherapy. Most spasmolytics acts centrally at the level of cerebrum, cerebellum, brainstem and/or spinal cord. Medical practitioner can prescribe spasmolytics as adjuncts in management of musculoskeletal condition and reduce spasticity in certain neurological conditions.

Common conditions treated by muscle relaxants

CP

Stroke with spasticity

Fibromyalgia

Huntington's disease

Migraine

Muscle spasm

Neuralgia

Nocturnal leg cramp

Tempomandibular joint (TMJ) disorder

Botulinum toxin-A

Commonly know as Botox. It is a type of muscle relaxant which is commonly used in children with cerebral palsy. Botox is injected into affect muscle to temporarily improve muscle tightness and tone. With reduced overactive of affect muscle, it will improve movement, hence improve the ease for caregivers to help a person with cerebral palsy to attain comfort and set up in a desire posture. It also provide a window for physiotherapist and occupational therapist to further intervene.[4]

During the window of opportunity, physiotherapist or occupational therapist can adopt serial casting, prescription of splint or orthosis, strengthening exercises, adaptive equipment or a combination of the above as treatment to improve range of motion, pain, independence and quality of life of the child or family.[5]

Short-term improvement in muscle tone is observed for three to six months.[4] Re-injection might be recommended followed by review assessment. Also, Botox is normally used as part of a multidisciplinary approach in management for CP patient, instead of stand-alone treatment.[6]

References

  1. Williams SA, Elliott C, Valentine J, Gubbay A, Shipman P, Reid S. Combining strength training and botulinum neurotoxin intervention in children with cerebral palsy: the impact on muscle morphology and strength. Disability and rehabilitation. 2013 Apr 1;35(7):596-605.
  2. Roche N, Zory R, Sauthier A, Bonnyaud C, Pradon D, Bensmail D. Effect of rehabilitation and botulinum toxin injection on gait in chronic stroke patients: a randomized controlled study. Journal of rehabilitation medicine. 2015 Jan 5;47(1):31-7.
  3. See S, Ginzburg R. Choosing a skeletal muscle relaxant. American family physician. 2008 Aug 1;78(3):365.
  4. 4.0 4.1 Managing Spasticity in Children with Botulinum Toxin Injections. Retrieved August 19, 2014, from http://www.chw.edu.au/kidsrehab/brain_injury/information_sheets/physical_changes/botulinum_toxin_injections.htm
  5. Love, S. C., et al. "Botulinum toxin assessment, intervention and after‐care for lower limb spasticity in children with cerebral palsy: international consensus statement." European Journal of Neurology 17 (2010): 9-37.
  6. Esquenazi A, Novak I, Sheean G, Singer BJ, Ward AB. International consensus statement for the use of botulinum toxin treatment in adults and children with neurological impairments–introduction. European journal of neurology. 2010 Aug;17:1-8.