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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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Things worth knowing about "Spasticity"

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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