Spasticity after spinal cord injury — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardFunctional, Rehabilitation and DVLASpasticity after spinal cord injurySCE Neurology

A patient with chronic cervical myelopathy has painful adductor spasms that impair hygiene. Infection, constipation, pressure injury and other triggers have been addressed. What mechanism and first treatment step best fit?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Baclofen and rehabilitation for disinhibited stretch reflexes

The best answer is “Baclofen and rehabilitation for disinhibited stretch reflexes”. Upper-motor-neurone injury reduces descending inhibitory control and increases spinal reflex excitability; treatment begins with agreed functional goals, trigger control, positioning and stretching, with antispastic medication when benefit outweighs weakness and sedation. “Cortical spreading depolarisation treated with a triptan” is less appropriate because cortical spreading depression mediates migraine aura rather than velocity-dependent tone “JC-virus oligodendrocyte infection treated with aciclovir” is less appropriate because JCV does not explain chronic stimulus-sensitive spasms after myelopathy “Trigeminal-autonomic activation treated with oxygen” is less appropriate because trigeminal-autonomic pathways produce cranial headache symptoms “Neuromuscular-junction blockade treated with pyridostigmine” is less appropriate because junctional failure causes fatigable flaccid weakness rather than clonus and extensor spasms

Reference: NICE NG220: Multiple sclerosis in adults — recommendations. https://www.nice.org.uk/guidance/ng220/chapter/Recommendations