Spasticity

Topic Overview

What is spasticity?

Spasticity is a condition in which muscles are tight or stiff. For example, your hand may stay clenched in a fist or your knee may be hard to bend. At times the muscles may jerk or spasm uncontrollably. It can interfere with your ability to move, speak, or walk normally.

What causes spasticity?

Spasticity usually occurs because of damage to the part of the brain or spinal cord that controls voluntary movement. It's often the result of a spinal cord injury, a stroke, or a disease such as multiple sclerosis, cerebral palsy, or amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease).

What are the symptoms?

Common symptoms include:

  • Increased muscle tone, which makes the muscles stiff or tight.
  • Overactive reflexes.
  • Muscle spasms.
  • Series of repeated quick muscle contractions (clonus).
  • Stiff joints.

If spasticity isn't treated, the muscles may freeze in an abnormal position. This can be very painful.

How is it treated?

The main treatments are physical therapy and medicines that help reduce muscle spasms. Surgery may be an option in severe cases.

Physical therapy

Exercise and stretching are important treatments for spasticity. Therapists will work with you to increase your range of motion and keep your muscles from getting stiff. You will need to move the affected limb over and over again on a regular basis. You may do this on your own or with the help of a therapist, machine, or caregiver.

In some cases, cold packs and electrical stimulation are used on muscles. Casts or splints may be used to stretch the muscles and keep them from contracting.

Medicines

Muscle relaxants (antispasmodics) are used to treat spasticity. They include baclofen (such as Gablofen) and tizanidine (Zanaflex). These medicines relax tight muscles and stop muscle spasms. But they may cause sleepiness, muscle weakness, and nausea.

Baclofen is the medicine most often prescribed for spasticity. You can take it as a pill, or a surgeon can implant a small pump under your skin that delivers the medicine directly to your spinal cord. The advantage of the pump is that you will use less medicine. This reduces the side effects that are a problem with baclofen pills. Your doctor can tell you if the pump is right for you.

Other medicines that may be used include gabapentin (such as Neurontin), diazepam (Valium), clonazepam (such as Klonopin), and dantrolene (Dantrium). In many cases, taking small doses of a combination of medicines works better and causes fewer side effects than taking a larger dose of a single medicine.

Botulinum toxin (such as Botox) injections given directly into the muscle can block messages that cause the muscle to spasm. The effect of one injection lasts about 3 to 4 months.

Some forms of natural or man-made substances related to marijuana, called cannabinoids, may help relieve spasticity. They are not available in all areas. Talk to your doctor if you are considering cannabinoids.

Surgery

Some people with severe spasticity may need surgery. For example, surgery may be done to:

  • Release the biceps or triceps tendon in the arm.
  • Lengthen the hamstring or Achilles tendon in a person who has problems walking.
  • Release the toe flexor muscles.

Other Places To Get Help

Organization

National Institute of Neurological Disorders and Stroke (U.S.)
www.ninds.nih.gov

References

Other Works Consulted

  • Keenan MAE, et al. (2014). Rehabilitation. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 595-642. New York: McGraw-Hill.
  • Koppel B, et al. (2014). Systematic review: Efficacy and safety of medical marijuana in selected neurologic conditions. Neurology, 82(17): 1556-1563. DOI: http://dx.doi.org/10.1212/WNL.0000000000000363. Accessed January 12, 2016.
  • Leussink VI, et al. (2012). Symptomatic therapy in multiple sclerosis: The role of cannabinoids in treating spasticity. Therapeutic Advances in Neurological Disorders, 5(5): 255-266. Also available online: http://tan.sagepub.com/content/5/5/255.abstract.
  • Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691-1698.

Credits

ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Martin J. Gabica, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerKarin M. Lindholm, DO - Neurology

Current as ofFebruary 16, 2018