Spasticity – Causes, Symptoms and Treatment
Spasticity is a condition of abnormal muscle stiffness caused by increased muscle tone due to damage to the central nervous system. It commonly occurs after stroke, in multiple sclerosis, or following spinal cord injuries.
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Spasticity is a condition of abnormal muscle stiffness caused by increased muscle tone due to damage to the central nervous system. It commonly occurs after stroke, in multiple sclerosis, or following spinal cord injuries.
What is Spasticity?
Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes, resulting in excessive or uncontrolled muscle stiffness and spasms. It arises from damage to the central nervous system (CNS) – the brain or spinal cord – which disrupts the normal regulation of muscle tone. The faster a spastic muscle is stretched, the greater the resistance felt, which is the hallmark of this condition.
Causes
Spasticity develops when the nerve pathways that control muscle tone (motor pathways) are damaged. Common causes include:
- Stroke (most common cause in adults)
- Multiple sclerosis (MS)
- Spinal cord injury or disease
- Cerebral palsy (most common cause in children)
- Traumatic brain injury (TBI)
- Amyotrophic lateral sclerosis (ALS)
- Brain tumors or meningitis
Symptoms
The symptoms of spasticity vary widely between individuals. Common signs and symptoms include:
- Muscle stiffness and tightness
- Involuntary muscle spasms or jerks
- Pain or discomfort due to sustained muscle tension
- Reduced range of motion in affected limbs
- Joint deformities known as contractures
- Difficulty walking, grasping objects, or performing daily activities
- Sleep disturbances caused by nocturnal muscle spasms
Diagnosis
Spasticity is diagnosed through a thorough neurological examination, during which the physician assesses muscle tone, deep tendon reflexes, and joint range of motion. The severity is often graded using the Ashworth Scale or the Modified Ashworth Scale (MAS). To identify the underlying cause, imaging studies such as MRI (magnetic resonance imaging) or CT (computed tomography) are commonly performed.
Treatment
Treatment of spasticity is individualized and depends on the underlying cause, the severity, and the impact on daily life. The goals are to reduce muscle tone, relieve pain, and improve functional mobility.
Physiotherapy
Regular physiotherapy is the cornerstone of spasticity management. Stretching exercises, positioning techniques, and targeted movement therapy help prevent contractures and maintain range of motion.
Medications
Several medications can be used to reduce excessive muscle tone:
- Baclofen (oral or intrathecal pump): acts on the spinal cord to reduce overactive muscle reflexes
- Tizanidine: a centrally acting muscle relaxant with good tolerability
- Diazepam and other benzodiazepines: used in severe cases
- Dantrolene: acts directly at the muscle fiber level
Botulinum Toxin Injections
Botulinum toxin (Botox) can be injected directly into overactive muscles to reduce their tone for several months. This approach is particularly effective for focal spasticity, where only specific muscle groups are affected.
Surgical Interventions
In severe cases that do not respond to other treatments, surgical options such as selective dorsal rhizotomy (cutting selected nerve roots) or orthopedic corrections may be considered.
Prognosis
Spasticity is in most cases a chronic condition requiring ongoing management. However, with consistent and comprehensive treatment, quality of life can be substantially improved. A complete resolution is only possible when the underlying cause can be fully addressed.
References
- Lance JW. The control of muscle tone, reflexes, and movement. Neurology. 1980;30(12):1303–1313.
- Pandyan AD et al. Spasticity: clinical perceptions, neurological realities and meaningful measurement. Disability and Rehabilitation. 2005;27(1-2):2–6.
- National Institute of Neurological Disorders and Stroke (NINDS). Spasticity Information Page. U.S. Department of Health and Human Services, 2023.
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