Spasticity is a very common symptom of MS. There are two types of MS-related spasms: flexor and extensor. Flexor spasticity is an involuntary bending of the hips or knees (primarily involving the hamstring muscles on the back of the upper leg). The hips and knees bend up toward the chest. Extensor spasticity is an involuntary straightening of the legs. Extensor spasticity involves the quadriceps (muscles on the front of the upper leg) and the adductors (inner thigh muscles). The hips and knees remain straight with the legs very close together or crossed over at the ankles. Spasticity may also occur in the arms, but is less common in people with MS.
Spasticity may worsen due to sudden movements or position changes, muscle tightness, temperature extremes, humidity or infections. It may even be triggered by tight clothing.
Symptoms
Spasticity may be as mild as the feeling of tightness in muscles or may be severe enough to produce painful, uncontrollable spasms of the extremities; most commonly the legs and arms. Spasticity may also create feelings of pain or tightness in and around joints and can cause low back pain.
Adverse effects of spasticity include:
- Muscle stiffness, causing movements to be less precise and making certain tasks difficult to perform
- Muscle spasms, causing uncontrollable and often painful muscle contractions
- Involuntary crossing of the legs
- Muscle and joint deformities
- Muscle fatigue
- Inhibition of longitudinal muscle growth
- Inhibition of protein synthesis in muscle cells
Additional complications
- Urinary tract infections
- Chronic constipation
- Fever or other systemic illnesses
- Pressure sores
Treatment Options
There are several types of treatment available that must be evaluated on a case-by-case basis, depending on the underlying cause, age of the patient and severity of the spasticity. Different treatments share the common goals of:
- Relieving the signs and symptoms of spasticity
- Reducing the pain and frequency of muscle contractions
- Improving gait, hygiene, activities of daily living and ease of care
- Reducing caregiver challenges such as dressing, feeding, transport and bathing
- Improving voluntary motor functions involving objects such as reaching for, grasping, moving and releasing
- Enabling more normal muscle growth in children
Physical and Occupational Therapy
Physical and occupational therapy for spasticity is designed to reduce muscle tone, maintain or improve range of motion and mobility, increase strength and coordination and improve comfort. Therapy may include stretching and strengthening exercises, temporary braces or casts, limb positioning, application of cold packs, electrical stimulation and biofeedback.
Oral Medications
The use of oral medications to treat spasticity may be indicated when symptoms interfere with daily functioning or with sleep. Effective medication management may require the use of two or more drugs or a combination of oral medications with another type of treatment. It is very important to work closely with a doctor to devise an individualized treatment plan. Side effects vary greatly by class of medication and patient.
Medications include:
- Baclofen
- Benzodiazepines
- Dantrolene sodium
- Imidazolines
- Gabapentin
Botulinum Toxin (BTA) Injections
BTA, also known as Botox injections, when used in tiny amounts, have proven effective in paralyzing spastic muscles. Injection sites are carefully determined based on the pattern of spasticity.
When Botox is injected into the muscle(s), the release of acetylcholine is blocked, resulting in a relaxation of overactive muscles. The injection(s) generally take effect within a few days and last about 12-16 weeks, until new nerve endings grow back and the affected muscle(s) recover. Functional benefits may last longer than this. There are limitations in the number of injections that can be administered.
Surgery
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