Spasticity
SOURCE: www.NationalMSSociety.org
Spasticity refers to feelings of stiffness and a wide
range of involuntary muscle spasms (sustained muscle contractions or
sudden movements). It is one of the more common symptoms of MS. Spasticity
may be as mild as the feeling of tightness of muscles or may be so severe
as to produce painful, uncontrollable spasms of extremities, usually of
the legs. Spasticity occurs when this coordination is impaired and too
many muscles contract at the same time.
Spasticity may also produce feelings of pain or tightness
in and around joints, and can cause low back pain. Although spasticity can
occur in any limb, it is much more common in the legs.
There are two types of severe MS-related spasticity
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In flexor spasticity, mostly involving
the hamstrings (muscles on the back of the upper leg), and hip
flexors (muscles at the top of the upper thigh), the hips and knees
are bent and difficult to straighten.
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In extensor spasticity, involving the
quadriceps and adductors (muscles on the front and inside of the
upper leg), the hips and knees remain straight with the legs very
close together or crossed over at the ankles.
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Spasticity may be aggravated by sudden movements or position changes, extremes
of temperature, humidity, or infections, and can even be triggered by tight
clothing.
Treatment with Exercise and Medication
There are a number of therapeutic approaches to the management of
spasticity. Because spasticity varies so much from person to person, it must be
treated on an individual basis and demands a true partnership between the person
with MS, physician, nurse, physical therapist, and occupational therapist.
Treatment begins with the physician recommending ways to relieve the symptoms,
including exercise, medication, changes in daily activities, or combinations of
these methods. The physician will track the progress and make referrals to other
health professionals such as
occupational
and physical therapists
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Daily stretching and other exercises are often effective in
helping to relieve spasticity.
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If drugs are also needed, there are two major antispasticity
drugs that have good safety records. Neither, however, can cure
spasticity or improve muscle coordination or strength.
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Baclofen, whether
oral or
IT, the most commonly used drug, is a muscle relaxant that
works on nerves in the spinal cord. Common side effects are
drowsiness and a feeling of muscle weakness. It can be administered
orally or by an implanted pump (intrathecal baclofen). Intrathecal
baclofen is used for severe spasticity that cannot be managed with
oral medication.
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Tizanidine (Zanaflex®) works quickly to calm spasms and relax
tightened muscles. Although it doesn't produce muscle weakness, it
often causes sedation and a dry mouth. In some patients, it may
lower blood pressure.
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Other, less commonly-used drugs, include:
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Diazepam (Valium®) —not a "first choice" drug for spasticity
because it is sedating and has a potential to create dependence.
However, its effects last longer with each dose than baclofen, and
physicians may prescribe small doses of Valium® at bedtime to
relieve spasms that interfere with sleep.
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Dantrolene (Dantrium®) —generally used only if other drugs have
not been effective. It can produce serious side effects including
liver damage and blood abnormalities.
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Phenol, a nerve block agent
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Botulinum toxin (Botox®) injections—have been shown to be
effective in relieving spasticity in individual muscles for up to
three months.
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Clonidine—still considered experimental
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Treatment Helps Prevent Complications
Left untreated, spasticity can lead to serious complications,
including contractures (frozen or immobilized joints) and pressure sores.
Since these complications also act as spasticity triggers, they can set
off a dangerous escalation of symptoms. Treatment of spasticity and muscle
tightness by medication and physical and occupational therapy is needed to
prevent painful and disabling contractures in the hips, knees, ankles,
shoulders, and elbows. Surgical measures are considered for those rare
cases of spasticity that defy all other treatments.
Spasticity Can Provide Some Benefit for People with Significant
Weakness
Some degree of spasticity can also provide benefit, particularly for
people who experience significant leg weakness. The spasticity gives their
legs some rigidity, making it easier for them to stand, transfer, or walk.
The goal of treatment for these individuals is to relieve the spasticity
sufficiently to ensure comfort and prevent complications, without taking
away the rigidity they need to function.
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