From the Guidelines
Doctors may not immediately treat brisk reflexes after diagnosis because these reflexes alone often don't require treatment unless they cause functional problems or indicate a progressive condition. Brisk reflexes, which can be a sign of spasticity, are typically treated in a stepwise approach, beginning with the least-invasive modalities and progressing to more invasive, as seen in the management of adult stroke rehabilitation care 1. This approach includes positioning, passive stretching, and range of motion exercise, which may provide relief and should be done several times daily in persons with spasticity.
The decision to treat brisk reflexes depends on the underlying cause, severity of symptoms, and whether the brisk reflexes are part of a larger neurological condition. In many cases, brisk reflexes are simply monitored over time to track any changes or progression. If treatment becomes necessary, options might include medications like baclofen, diazepam, or tizanidine to reduce muscle tone and spasticity, typically starting at low doses and gradually increasing as needed, as these are FDA-approved oral medications in the United States for the treatment of spasticity 1.
Some key points to consider in the treatment of brisk reflexes include:
- The potential for contractures, which can render the affected limb functionless, and the importance of corrective measures such as splinting, serial casting, or surgical correction 1.
- The limited evidence from controlled trials of spasticity treatment in stroke patients, which suggests that spasticity and pain may be reduced but that no significant functional gains are made 1.
- The potential side effects of medications, such as sedation, and the need to balance the benefits of treatment with the potential risks to the patient's quality of life and function. Physical therapy is often recommended before medication to improve muscle function and prevent contractures, highlighting the importance of a conservative approach that prioritizes the patient's overall well-being and functional ability.
From the Research
Brisk Reflexes Diagnosis and Treatment
- Brisk reflexes, also known as hyperreflexia, can be a symptom of various neurological conditions, including upper motor neuron lesions 2.
- After diagnosing brisk reflexes, doctors may not immediately treat the condition with medication or other interventions, as the treatment approach depends on the underlying cause and severity of the symptoms.
- In some cases, treatment may focus on managing the underlying condition, such as spasticity, which can be a common symptom of upper motor neuron dysfunction 2.
Treatment of Spasticity
- Spasticity can be treated with a range of therapies, including physical therapy, pharmacotherapy, and surgery 2.
- Pharmacotherapy for spasticity may involve the use of medications such as baclofen, diazepam, tizanidine, and dantrolene 2.
- Botulinum toxin type A (BoNT-A) has also been shown to be effective in treating spasticity, particularly in cases where focal spasticity is present [(3,4,5)].
Rationale for Delayed Treatment
- Doctors may delay treatment for brisk reflexes or spasticity if the symptoms are mild or not causing significant discomfort or disability 2.
- In some cases, treatment may be delayed to allow for further evaluation or to determine the underlying cause of the symptoms 2.
- Additionally, treatment with medications such as BoNT-A may be delayed due to concerns about potential side effects or the need for repeated injections 6.