Spasticity

In spasticity, muscles tighten and stiffen. This involuntary muscle flexing sometimes interferes with movement, posture, or balance. Spasticity can range from mild muscle stiffness to severe, painful, and uncontrollable muscle spasms. The cause is usually damage or injury to part of the brain or spinal cord that controls voluntary movement. Spasticity may result from spinal cord injury, multiple sclerosis, cerebral palsy, stroke, or brain or head trauma. It can also occur in amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), and inherited conditions or metabolic disorders. Symptoms may include increased muscle tone, a series of rapid muscle contractions, exaggerated deep tendon reflexes, muscle spasms, scissoring of the legs, and fixed joints.

Treatments can involve muscle stretching and range-of-motion exercises to help prevent shrinkage or shortening of muscles and reduce symptoms. Botulinum toxin injection may be used to selectively weaken extremely stiff muscles to improve range of motion and function. Medications prescribed for spasticity can include baclofen, diazepam, tizanidine or clonazepam. If medication taken by mouth for spasticity is unreliable, difficult to absorb, or causes intolerable side effects, an option is to deliver liquid anti-spasm medicine such as baclofen to the fluid around the spine. This is done using a surgically placed pump and catheter. Because the space where the drug is delivered is called the intrathecal space, this method is known as intrathecal drug delivery. For some patients, this type of infusion can offer a more stable means of controlling spasticity than medication taken by mouth. Finally, surgery may be recommended to ease rigidity by releasing a tendon, realigning a bone, or intentionally cutting select nerves in the lower spine. (1, 2)

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Either injury to the brain or spinal cord can cause spasticity . . .

References:

1. National Institute of Neurological Disorders and Stroke. NINDS Spasticity Information Page. https://www.ninds.nih.gov/Disorders/All-Disorders/Spasticity-Information-Page. Accessed Dec. 15, 2020.

2. Neuromodulation using intrathecal baclofen therapy for spasticity and dystonia;Uchiyama T, Nakanishi K, Fukawa N, Yoshioka H, Murakami S, Nakano N, Kato A; Neurologia Medico-Chirurgica (Tokyo) 52 (7), 463-9 (2012)

Reviewed March 10, 2013
Konstantina Petropoulou MD, PhD
Member, International Neuromodulation Society
Head of 2nd PRM Department
National Rehabilitation Center
Athens, Greece

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