What is spasticity?
Spasticity is disruption in muscle movement patterns so that muscles contract all at once. Muscle movements are normally controlled by a complex system that allows some muscles to contract (tighten) while others relax. Damage to nerves in the central nervous system can disrupt the pattern. As a result, many muscles may contract all at once. This condition can be found in cerebral palsy, traumatic brain injury, stroke, spinal cord injury, multiple sclerosis, and other conditions that affect the brain and/or spinal cord. Spasticity mostly occurs in the legs but can occur in the arms.
Symptoms and Causes
What are symptoms of spasticity?
- Increased muscle tone
- Involuntary movements
- Spasms (quick and/or sustained involuntary muscle contractions)
- Clonus (series of fast involuntary contractions)
- Pain or discomfort
- Less ability to function
- Problems with care and hygiene
- Abnormal posture
- Contracture (permanent contraction of the muscle and tendon due to severe lasting stiffness and spasms)
- Bone and joint deformities
- Decreased quality of life
Management and Treatment
When is spasticity treated?
Spasticity should be treated when it causes pain, interferes with activities of daily living or sleep, or leads to less ability to function. Treatment is developed based on the patients needs, preferences and goals.
What are some non-medical treatments for MS-related spasticity?
Spasticity can be reduced by:
- Performing stretching exercises daily. Prolonged stretching can make muscles longer, helping to decrease spasticity and prevent contracture.
- Splinting, casting, and bracing. These methods are used to maintain range of motion and flexibility.
What are some medical treatments used for MS-related spasticity?
Oral medications used to treat spasticity include:
- Baclofen (Lioresal®)
- Tizanidine (Zanaflex®)
- Dantrolene sodium (Dantrium®)
- Diazepam (Valium®)
- Clonazepam (Klonopin®)
- Gabapentin (Neurontin®)
What are the pros and cons of oral medications?
Oral medications have benefits as well as disadvantages. Advantages include:
- Oral medications can relax a large number of muscles.
- The dosage of oral medications is easily adjusted.
- Oral medications may be stopped at any time. However, many drugs should not be stopped abruptly.
- The effect of oral medications may be modest.
- Drowsiness is a common side effect. Dizziness and weakness may occur.
- Some medications may cause liver inflammation.
What are other options for treating spasticity?
Local injections into spastic muscles may be very effective. These shots can reduce tone selectively in muscles that are causing the most spasm. Injections may involve botulinum toxin [Botulinum Toxin A (Botox®) and B (Myobloc®)] or phenol.
During botulinum toxin injections, the toxin is injected directly into the muscle, making spastic muscles weaker. This may improve positioning and function. The effects usually take 7 to 10 days to become noticeable. The effects last from 3 to 6 months.
- Intrathecal baclofen therapy (ITB): ITB therapy is used to treat severe spasticity. Baclofen is delivered directly to the spinal cord by a programmable pump and catheter. Because the drug is placed directly at the site of action within the spinal cord, much less baclofen is needed, and there are fewer side effects than if the drug were taken by mouth. Patients must undergo an ITB screening test prior to having a pump placed.
- Orthopedic surgery, or surgery that deals with treating muscles, bones, and connective tissue
- Neurosurgery, or surgery that deals with treating the brain, spinal cord, and nerves
The best way to treat spasticity usually means having an active patient or support person and caregivers who work with a team of healthcare professionals with different specialties. Members of this team may include one or more of the following individuals:
- Physiatrist, a rehabilitation doctor
- Advanced practice clinician
- Physical therapist
- Occupational therapist
- Speech language pathologist
- Orthopedic surgeon