Many people with multiple sclerosis experience spasticity, or muscle stiffness and spasms. It usually affects the muscles of the legs and arms, and may interfere with the ability to move those muscles freely.
Spasticity can occur either as a sustained stiffness caused by increased muscle tone or as spasms that come and go, especially at night. It can feel like a muscle tightening or it can cause severe pain. Spasticity can also produce feelings of pain or tightness in and around joints and can cause low back pain. The intensity may vary depending on your position, posture, and state of relaxation.
What Causes Spasticity in Multiple Sclerosis?
Spasticity is the result of an imbalance in the electrical signals coming from the brain and spinal cord, often caused by damage to these areas from by multiple sclerosis. This imbalance causes hyperactive muscle stretch reflexes, which result in involuntary contractions of the muscle and increased muscle tension.
What Triggers Spasticity Due to Multiple Sclerosis?
For someone who has multiple sclerosis, spasticity may be aggravated by extremes of temperature, humidity, or infections. It can even be triggered by tight clothing.
How Is Spasticity Diagnosed?
To diagnose spasticity your doctor will first evaluate your medical history, including what medications you have taken and whether there is a history of neurological or muscular disorders in your family. To confirm the diagnosis, several tests can be performed to evaluate your arm and leg movements, muscular activity, passive and active range of motion, and ability to perform self-care activities.
How Is Spasticity Treated if I Have Multiple Sclerosis?
If you suffer from multiple sclerosis, spasticity can be treated using physical therapy, medications, surgery, or any combination of these treatments. Your doctors will consider the severity of your condition, your overall health, and the following factors when prescribing an appropriate treatment plan:
• Is the spasticity affecting function or independence?
• Is the spasticity painful?
• What treatment options have already been tried, and how did they work?
• What are the costs of the possible treatments?
• What are the limitations and side effects of the treatment?
• Will the benefits outweigh the risks?
How Does Physical and Occupational Therapy Help Spasticity?
A basic physical therapy stretching program is the first step in treating spasticity linked to MS. A daily regimen of stretching can lengthen muscles to help decrease spasticity.
An occupational therapist may prescribe splinting, casting, and bracing techniques to maintain range of motion and flexibility.
If physical and occupational therapy do not adequately control the spasticity, medications may be added to the treatment plan.
What Drugs Are Used to Treat Spasticity?
Common drugs used to treat spasticity include the muscle relaxants baclofen and Zanaflex.
Another drug that might be used to treat spasticity is Valium, which is often helpful when taken at night to relieve spasms that interfere with sleep.
If medications taken orally are not effective, a pump can be surgically implanted to deliver the medication (such as the baclofen pump). Botulinum toxin (or Botox) can also be injected locally into the affected area to relax the muscles.
What Types of Surgery Are Available for Spasticity?
When other treatments fail, rhizotomy and tendon release are two surgical procedures used to treat spasticity.
Rhizotomy involves surgically cutting away part of the spinal nerve. It is performed to relieve pain or decrease muscle tension.
Tendon release, also called a tenotomy, may be performed to help reduce the frequency or magnitude of the spasticity, depending on the age of the patient. The surgery involves cutting severely contracted tendons away from the muscles to which they're attached.
Tendon release may need to be repeated.
These surgeries are usually only done in extreme cases that do not respond to other treatments.