Spasticity is caused by damage to the brain and/or spinal cord from MS or other conditions. Reflexes become hyperactive, resulting in increased muscle tone, muscle stiffness and tightness, cramps, spasms, clonus (involuntary shaking), pain, and difficulty controlling the muscles. Some people with MS report that they have to “fight their muscle tightness” to move when they have spasticity. This is because muscles contract when they shouldn't, and don't relax when they should.
Some surveys estimate that more than 80 percent of the people with MS will experience spasticity at some time, and not everyone is affected in the same way. MS-related spasticity seems to affect the legs more than the arms and hands. Spasms may disrupt sleep, increasing fatigue and weakness during the day. Difficulty moving the limbs passively can make it more difficult for caregivers to perform hygiene. Also, discomfort can interfere with many activities.
Addressing Spasticity with Your Healthcare Provider
Untreated severe spasticity can have serious negative consequences. Mention all symptoms related to spasticity to your healthcare provider, even the mildest ones. This does not necessarily mean that you will need a medication for spasticity, but simple measures can be initiated to alleviate even the slightest effect of spasticity and help prevent it from becoming a major problem.
The spasticity assessment done by a doctor or nurse provides information that will help evaluate the presence and severity of the spasticity, determine its effect, and measure response to treatment. Your examiner will look for: increased reflexes, resistance to passive movement, decreased range of motion, observed spasms and clonus, and the quality of movement when you use your arms or your legs. Other impairments that interfere with function, such as weakness, loss of sensation, or loss of coordination, will be considered as well.
Your neurologist will be on the front line assessing your needs, perhaps along with a nurse practitioner or physician assistant, but other types of healthcare providers can help with different aspects of managing and treating your spasticity. They include a physiatrist, physical therapist, neurosurgeon, and orthopedic surgeon.
Developing a Treatment Plan
All the treatments described are symptomatic, meaning that they do not treat the disease of MS, which may continue to progress. The ideal is to detect spasticity before it causes significant trouble, and to use available treatment options to achieve realistic goals. For example, if the goal is to improve walking, stretching and oral medications will usually be combined with physical therapy, and sometimes with the use of devices.
Goals for spasticity management include improving comfort, posture, personal care and hygiene, as well as occasionally improving function. The goals, as well as the pros and cons of each treatment, need to be discussed with your healthcare provider, and it is important to evaluate the results of the treatment in order to optimize the treatment plan.
Treatments can be combined to maximize the chances of success. The first step involves eliminating possible antagonists, such as a urinary tract infection, pressure sore, or other physical stress on the body. When these underlining problems are resolved the increase of the spasticity may also be resolved.
Lifestyle changes can be helpful, for example minimizing stress and fatigue, stretching every day, relaxation, yoga, and exercise. Braces or walking aids may increase mobility, although it is important to note that spasticity can be helpful at times because it can compensate for some of the weakness in the legs and may be giving the support needed to walk.
Medication and Other Options
Spasticity can be treated with symptom medications, such as baclofen, tizanidine, gabapentin, benzodiazepines, or dantrolene. The most common side effects with these medications are drowsiness, dizziness, and weakness. The general rule is to start with a low dose and increase it slowly until spasticity is controlled or side effects occur.
When spasticity is limited to a few muscles, or when it is preferable to limit the treatment to a few muscles, then local injections can be given to selectively relax these muscles. Examples include phenol injections and botulinum toxin injections. Surgery is occasionally performed to release tendon contractures.
People with severe MS spasticity who failed other treatments may be candidates for intrathecal baclofen therapy (ITB therapy). This treatment involves surgically implanting a baclofen pump under the skin of the abdomen, and inserting a catheter into the spine to deliver baclofen directly into the spinal fluid. Baclofen administered this way is more effective and usually does not cause sedation. However, because of the risks involved, candidates for ITB therapy need to be carefully selected and tested.
Resources for further reading can be found at www.wemove.org.
Darlene Stough, RN, MSCN, CCRP has worked as a registered nurse for the Cleveland Clinic for 27 years in various specialty areas. Darlene is both a certified MS nurse and a certified clinical research professional. For over the past eight years she has been the nurse coordinator for research projects on symptomatic therapies and rehabilitation in MS at the Mellen Center for MS Treatment and Research at the Cleveland Clinic Neurological Institute.
(Last reviewed 7/2010)