Spasticity

Spasticity is a condition in which muscles stiffen or tighten.  Thus, it prevents usual fluid movement. The muscles stay contracted, resisting stretching and affecting movement, gait, and speech.

CAUSES

Spasticity is usually caused by damage or disruption to the areas of the brain and spinal cord responsible for controlling muscle and stretch reflexes. This may originate from an imbalance in the inhibitory and excitatory signals sent to the muscles, causing them to lock in place. Spasticity may be harmful to growing children, as it may affect muscles and joints. People who have cerebral palsy, brain injury, spinal cord injury, or multiple sclerosis may have differing degrees of spasticity.

SYMPTOMS

May range from mild stiffness or tightening of muscles to painful and uncontrollable spasms. Pain or tightness in joints is also common in spasticity.

• Involuntary crossing of the legs
• Muscle and joint deformities
• Muscle stiffness, prompting movements to be less precise and making certain tasks difficult to perform
• Inhibition of longitudinal muscle growth
• Inhibition of protein synthesis in muscle cells
• Muscle spasms, prompting uncontrollable and typically painful muscle contractions
• Muscle fatigue

Complications

• Urinary tract infections (UTI)
• Fever or other systemic illnesses
• Frozen joints
• Pressure sores
• Chronic constipation

WHEN & HOW TO SEEK MEDICAL CARE

Seek medical care when spasticity is experienced for the first time and it has no known cause.  Also seek care if the spasticity is worsening and becoming more frequent, as well as when pain is experienced due to stiff joints and muscles. Lastly, seek care if the condition is preventing the performance of everyday tasks. Prolonged and untreated spasticity may lead to frozen joints and/or painful pressure sores on the skin. Begin by contacting your primary care doctor, who may refer you for further testing or physical therapy.

TESTING & DIAGNOSIS

Because of the varying degrees of spasticity, diagnosis may not be simple. A physical examination with neurological testing will be done to test for spasticity and the severity of it. Imaging such as an MRI may provide more information on the source of spasticity and the extent of the damage that has caused it.

TREATMENT

There are several treatment options for spasticity. Patients often undergo more than one at a time.

The following treatments have been shown to effectively alleviate symptoms and improve quality of daily life.

Non-Surgical Treatments

• Physical therapy
• Occupational therapy
• Casting or bracing
• Oral Medications: Only used in combination with other treatments if symptoms interfere with daily functioning or sleep. They include
  • Baclofen
  • Benzodiazepines
  • Dantrolene sodium
  • Imidazolines
  • Gabapentin
• Botulinum Toxin (Botox) Injections: May be used to paralyze the spastic muscle preventing it from contracting. In small doses, Botox is injected into carefully selected sites determined based on spasticity patterns. May last up to 12-16 weeks, but, due to the plasticity of the nervous system, new nerve endings will form and the muscle will no longer be inhibited by the Botox. Additionally, there is a limited number of injections that may be administered.

Surgery

• Intrathecal Baclofen (ITB) Pump: A pump may be surgically placed in a patient’s abdomen, releasing a steady dose of baclofen directly to the spinal fluid. This allows for a significant reduction in spasticity and pain with fewer side effects compared to taking baclofen orally. Should only be considered in extreme cases. It has also been found to be most effective in treating spasticity in the lower and upper extremities.
• Selective Dorsal Rhizotomy (SDR): Spasticity may be caused by an imbalance in electrical signals sent to antagonist muscles. SDR rebalances these signals by cutting selective nerve roots. This treatment is only done in severe spasticity of the legs. With proper and precise indication of the problematic nerve roots, cutting these roots will decrease muscle stiffness, while maintaining other functions. SDR is most commonly used in patients with cerebral palsy.

FOLLOW-UP

Patients should follow up with their primary care or specialty doctor regularly to ensure proper treatment. Typically, for surgeries such as baclofen pump placement, their neurosurgeon who sees their patients three months, six months and 12 months postoperatively. Additionally, they see their patients for medicine dosing appointments and any device-related appointments. Patients taking oral medications or doing physical and/or occupational therapy should follow-up with their doctors as instructed and needed.