Multiple Sclerosis Centers of Excellence
Ileana Howard, MD and Daniel Pierce, MD
Spasticity is a common symptom affecting many people with neurological diseases, including those with MS. Although the stiffness associated with spasticity can sometimes be helpful when performing daily activities such as getting in and out of a wheelchair or walking, spasticity can also be a nuisance and even lead to serious health concerns such as pain, wounds, or loss of function. The good news is that there are a growing number of treatments available to help ease the burden of troublesome spasticity. All people living with MS, their caregivers, and/or loved ones should have a basic understanding of the signs of spasticity, as well as an understanding of the various options to keep spasticity in check.
Is this spasticity?
Generally, spasticity is experienced as increased tightness of a body part or involuntary movements. For some, spasticity means one or both legs make uncontrolled bouncing or jumping motions. For others, spasticity may be a tight arm that makes it difficult to wash the underarm area during showers or a feeling of tightness that makes a stretching program painful or difficult. When in doubt, it is helpful to ask a therapist, neurologist, or rehabilitation provider to evaluate suspicious symptoms and tease out spasticity from other conditions.
Why is spasticity acting up now?
Many different environmental and medical changes can cause a sudden increase in spasticity and it is important to determine the underlying cause. Common triggers for increased spasticity include a bladder or urinary tract infection, skin wound, or kidney/bladder stones. Before starting or changing treatment for spasticity, your health care provider might recommend a physical exam, blood or urine tests, or imaging studies to look for one of these “spasticity triggers.” With time, many people living with spasticity can recognize the signs to help identify any underlying triggers.
Are there treatment options for spasticity?
Luckily, there are a wide variety of possible treatments for spasticity. Because each treatment option is unique in how it affects the body, it is important to discuss the specific goals of spasticity treatment with a health care provider. These treatments do not cause the muscles to get any stronger, however, many daily tasks can become easier to perform when the overactive muscles are controlled.
Stretching and Therapies
In all cases, overactive muscles causing tightness or spasticity should be regularly stretched multiple times per day to maintain range of motion and minimize the symptoms of spasticity. We believe that prolonged stretches (at least 20-30 seconds at a time) are the most effective to treat spasticity. When needed, physical or occupational therapists can help set up a stretching program, evaluate for and provide splints to provide a longer lasting stretch (over hours rather than minutes), and also provide useful “tricks” to quiet spasticity and permit more stretching. Many of these tricks or “modalities” - such as using ice, vibration, or electrical stimulation - have been used for over a half century to treat spasticity and are still commonly used today. While the results from these treatments might not last a long time (typically, less than an hour), the positive side is that most of these treatments can be done at home, can be controlled by the person living with MS or caregiver, and have little to no side effects.
There are many different classes of oral medications that can address problematic spasticity. These medications - such as baclofen, tizanidine, diazepam, gabapentin, and others – work by relaxing overactive muscles and can provide longer-lasting relief of spasticity (typically, hours at a time). Since these medications affect the entire body, side effects, such as drowsiness or weakness, are not uncommon. Most of these medications are taken multiple times each day in order to prevent or suppress spasticity.
Spasticity can also be treated by injections, such as botulinum toxin (Botox®), phenol, or alcohol, into the overactive muscles. These injections can be a good option for individuals with spasticity affecting a few individual muscles (rather than the whole body) since they are able to block communication from the nerve to the muscle that was injected. One advantage to this treatment is that one round of injections can have effects lasting several months. In addition, since they do not affect the entire body, they do not cause many of the side effects of the oral medications, such as drowsiness. One possible disadvantage, however, is that because these treatments work by weakening the muscles, activities requiring the use of those muscles could be negatively affected. Furthermore, if the injection is not helpful it can take a few months to wear off. Before the injections are performed, a thorough discussion with a health care provider can provide further insight into your individual risk versus benefit.
Intrathecal Baclofen Pump
When spasticity affects a larger region of the body, particularly the legs, an intrathecal baclofen pump is another possible option for treatment. This device is placed into the back by a neurosurgeon and delivers very small amounts of baclofen, an antispasticity medication, directly to the spinal canal. The benefit of this intervention is that the medication is delivered directly to the place it needs to go to (without having to take pills), and the treatment is adjustable to meet an individual’s needs over time. The drawback of this treatment is the surgical procedure to implant the pump, potential for device malfunctions, and routine clinic visits to adjust and refill the pump.
In summary, many individuals with MS will experience spasticity, and a significant proportion of those individuals will have undesirable impacts as a result. Troublesome spasticity can usually be managed effectively when it is recognized and addressed early. The best outcomes result when patients and health care providers work together to identify and manage spasticity symptoms.