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Spasticity is a condition
in which muscles contract or tighten involuntarily.
It can involve many muscles, diffuse spasticity,
or only a few muscles, focal spasticity.
Spasticity is caused by damage to nerves
in the central nervous system
that interrupt the normal pattern of reflexes
which in turn affects muscle contraction.
Spasticity occurs in conditions
that affect the brain and/or spinal cord
including cerebral palsy, traumatic brain injury,
stroke, spinal cord injury, and multiple sclerosis.
Spasticity often affects the legs
but can also occur in the arms and in the neck and trunk.
The symptoms of spasticity include:
increased muscle tone;
involuntary movements,
these include spasms, involuntary muscle contraction,
and clonus, a series of fast involuntary contractions
that feel like a tremor;
pain or discomfort;
less ability to function;
problems with care and hygiene;
abnormal posture;
contracture, a permanent tightening of the muscle and tendon
caused by severe stiffness and spasms;
bone and joint deformities;
and a lower quality of life.
Diagnosis.
To make a diagnosis of spasticity,
the doctor will perform a physical examination
and ask the patient about his or her medical history.
The doctor will also analyze the patient's posture,
movements, coordination, and strength.
As part of this analysis,
the doctor will stretch various muscles
to assess how tight they are.
The doctor may order certain tests
to understand what causes spasticity
such as an MRI to look for damage
in the central nervous system.
In many cases, the cause of spasticity is already known
and the goal of the assessment is to determine
how best to minimize its impact.
Treatment.
Spasticity should be treated
when it causes pain or discomfort,
interferes with activities of daily living or sleep,
or affects the ability to function.
The treatment plan is developed
based on the patient's needs, preferences, and goals.
The best way to treat spasticity
usually means having an actively involved patient
or support person and caregivers who work with a team
of healthcare professionals from different specialties.
Members of this team may include
one or more of the following individuals:
a neurologist; physiatrist, a rehabilitation doctor;
physician assistant; nurse practitioner; nurse;
physical therapist; occupational therapist;
speech language pathologist; neurosurgeon;
or orthopedic surgeon.
Spasticity can be treated in various ways
both non-medically and medically.
The effects of spasticity can be reduced
in the following ways:
performing stretching exercises daily,
prolonged stretching can make muscles longer
which helps to decrease spasticity and prevent tightening;
performing an adapted exercise routine as often as possible;
and splinting, casting, and bracing.
These methods are used
to maintain range of motion and flexibility.
Spasticity can also be treated with oral medications
which include baclofen, tizanidine, dantrolene,
diazepam, clonazepam, and gabapentin.
Advantages of oral medications include the following:
they can relax a large number of muscles,
the dosage is easy to adjust,
and oral medications may be stopped at any time.
However, some drugs should not be stopped abruptly.
Disadvantages of oral medications include the following:
the effect may be modest,
drowsiness is a common side effect,
dizziness and weakness may occur,
and some medications may cause liver damage.
Your doctor will review the instructions
and potential side effects of these medications with you.
Botulinum toxin injections.
Botulinum toxin can be injected into spastic muscles.
Preparations of botulinum toxin available in the US include:
onabotulinum toxin A or Botox,
abobotulinum toxin A or Dysport,
incobotulinum toxin A or Xeomin,
and rimabotulinum toxin B or Myobloc.
These injections can reduce tone selectively in muscles
where spasticity is the most bothersome.
Botulinum toxin is particularly helpful
with focal spasticity.
Although botulinum toxin injections are usually safe
and well-tolerated, in rare cases,
the effects from the medication
can spread outside the muscles injected
and cause complications.
The botulinum toxin is injected
directly into the spastic muscle.
The effects usually take seven to 10 days
to become noticeable and last about three months.
Baclofen pump.
A therapy known as intrathecal baclofen
is used to treat severe diffuse spasticity.
The medication baclofen is delivered
directly into the spiral fluid
by a surgically implanted programmable pump and catheter.
Because the drug is delivered close to the spinal cord,
much less baclofen is needed to achieve muscle relaxation.
Therefore, there are fewer side effects like drowsiness
than if the drug were taken by mouth.
However, weakness can occur
and potential complications specific to this treatment
must be taken into account.
For this reason, patients must undergo a screening test
before the pump is placed to ensure that they can benefit
from intrathecal baclofen therapy.
Results of spasticity management.
Although managing the symptoms of spasticity
does not treat the underlying condition or injury,
it can improve the patient's comfort and range of motion.
It can also make care easier
and in some cases can improve the patient's ability
to perform daily activities.
Thank you for choosing Cleveland Clinic for your care.
If you have any questions, please ask your caregivers.
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