Spasticity and MS: How to Control Your Muscles

 

From WebMD Editorial Contributors

Many people with multiple sclerosis have stiff muscles and spasms, a condition called spasticity. It happens mostly in the muscles of the legs and arms, and it may keep you from moving your limbs freely.

You might feel spasticity either as stiffness that doesn’t go away or as movements you can’t control that come and go, especially at night. It can feel like a muscle tightening, or it can be very painful. Spasticity also can make you ache or feel tight in and around your joints and low back. How you feel can vary depending on your position, posture, and how relaxed you are.

What Causes Spasticity?

Spasticity happens because of an imbalance in the electrical signals coming from the brain and spinal cord, often when multiple sclerosis has damaged the nerves there. This unevenness makes your muscles contract on their own and makes them tense.

The condition can get worse when it’s too hot or cold, when you have an infection, or if you’re wearing tight clothing.

Treatment for MS Spasticity

Physical therapy, medications, surgery, or a mix of these treatments can ease spasticity when you have MS. To decide the best way to help you, your doctors will think about your overall health, how severe your symptoms are, and:

Does the condition keep you from doing everyday tasks?

Are you in pain?

Which treatments have you tried, and how well did they work?

How much will it cost?

What are the side effects?

Will the benefits outweigh the risks?

Physical and Occupational Therapy for Spasticity

Most of the time, a physical therapist will start treating MS spasticity with a basic physical therapy stretching program. The goal is to lengthen your muscles to ease the condition.

An occupational therapist may recommend different tools, like splints, casts, or braces, to keep up your range of motion and flexibility.

If physical and occupational therapy don’t help, your doctor may want you to try medications.

Medications for Spasticity

Doctors can choose from among several kinds of medications to treat MS-related spasticity. They include:

Skeletal muscle relaxants. These drugs relieve the muscle tension of spasticity. Some work directly on your muscles, and others act through your nervous system. One of the most common medications for spasticity is the muscle relaxant baclofen (Ozobax). Doctors also sometimes prescribe dantrolene (Dantrium). If pills don’t work, your doctor might be able to put a pump inside your body to deliver the medication directly to your spinal fluid (such as the baclofen pump).

Benzodiazepines. These are nervous system depressants, which means they slow down messages in your nervous system. They include diazepam (Valium) and clonazepam (Klonopin). They can also help you sleep if nighttime spasms keep you awake. You might also hear them called tranquilizers. They aren’t FDA-approved for treating MS symptoms. So they’re usually prescribed along with another medication, or if other drugs haven’t worked.

Botulinum toxin. You can also get shots of botulinum toxin (such as Botox or Myobloc) to relax your muscles. It blocks the nerve messages that tell your muscles to tighten up. It’s not suitable for use in large areas, so it’s best for spasticity that’s limited to one part of your body. It’s also temporary. Each shot lasts 3-4 months.

Alpha2-adrenergic agonists.Tizanidine (Zanaflex) works through your central nervous system to ease spasticity. It relaxes your muscles by decreasing nerve stimulation. Its effects are similar to those of baclofen, and it’s sometimes prescribed along with baclofen.

Your doctor might prescribe other medicines to treat some of the effects of spasticity. For some people, spasticity can lead to symptoms like pain or restless legs syndrome.

Some studies have shown that products made from cannabis (marijuana) can ease spasticity, though we need more research into this. Smoking marijuana has not been shown to have the same effect and could be harmful to people with MS. Ask your doctor if cannabis products might help you.

When Does Surgery Help?

When other treatments don't work, there are two types of surgery that can treat spasticity.

In one type, a surgeon cuts away part of the spinal nerve. The operation is called rhizotomy. The goal is to relieve pain or ease muscle tension.

Tendon release, also called a tenotomy, is the second type. A surgeon cuts severely tight tendons away from the muscles. It may make spasticity happen less often and make it less severe, depending on how old you are. Over time, you may need to have the surgery again.

These surgeries can help, but they’re usually only for extreme cases of spasticity and are rarely performed in patients with MS..

 

New Study: Sexual Function and Satisfaction May be Low and Linked to Other Symptoms in People with MS

 

More than one third of 702 people with MS and minimal disability had low levels of sexual function and satisfaction, in a new study reported by researchers at Brigham & Women’s Hospital. Decreases in sexual function and satisfaction over time were linked to increased disability and increased symptoms such as fatigue and depression.
 
People with MS and healthcare professionals may hesitate to discuss sexual problems; findings like these highlight how important it is to consider if these are affecting your quality of life, and if you can improve them.

Background: Sexual arousal begins with the brain sending messages to the sexual organs along nerves running through the spinal cord. If MS damages these particular nerve pathways, sexual response can be directly affected. MS symptoms such as fatigue, spasticity, or mood changes can also contribute to sexual problems indirectly.

This Study: The researchers looked at 702 people with MS who are enrolled in the CLIMB study (Comprehensive Longitudinal Investigation of MS at the Brigham and Women's Hospital), an ongoing study that is following more than 2000 people with MS to figure out what factors affect the course of MS. Participants completed annual questionnaires for several years on quality of life, fatigue and depression. The group included 526 people who self-identified as female and 176 who self-identified as male. The average age was 42, and disability levels were low.

Results: Among the 702 participants, 38% reported low sexual function and 45% reported low sexual satisfaction. Being older and having MS longer were linked to sexual problems. Participants whose satisfaction and function decreased over time were more likely to have increased fatigue, depression, or disability over that time period as well. Although all aspects of quality of life were associated with sexual function and satisfaction, there were differences between males and females in the strength of these connections. For example, in women, low sexual satisfaction was strongly linked to fatigue. In men, low function was strongly linked to emotional factors.

Why This Matters: This study highlights the importance of discussing sexual problems with healthcare providers, even early in the course of MS before having physical disability. Seeking treatments for potentially modifiable symptoms such as depression or fatigue may help increase sexual function and satisfaction.

This study:
“Sexual Problems in MS: Sex Differences and Their Impact on Quality of Life” by Drs. T. Kaplan , T. Feldman , B. Healey , M. Behn , B. Glanz , and T. Chitnis, is published in Multiple Sclerosis and Related Disorders (Published:March 26, 2023).

 

How to Prevent MS Flare-Ups

 

To try to prevent a flare-up from happening:

Take meds as directed. The drugs your doctor prescribes help slow your MS from getting worse and help prevent relapses. If you have side effects, don't just stop taking them. One study found about 25% of MS patients who stopped taking their meds had a relapse. Certain meds for Crohn’s disease or rheumatoid arthritis may cause MS-like symptoms. So can drug interactions. Check with your doctor to see if there are meds you’re taking that could be interacting with one another, and if your current meds are right for you. 

Stay healthy. A bout of cold or flu can set off your MS symptoms. A bladder infection can trigger either a flare or a pseudo-flare, so the same advice applies. In fact, infections cause a third of MS flare-ups. Wash your hands with warm water and soap during the day, get your yearly flu shot, and avoid people who look sick. Stay hydrated. Try to avoid anyone who is sick. Make sure your food is cooked properly. Practice safe sex.Ask your doctor for other ways to avoid bladder infections, including vaccinations. Try to avoid anyone who is sick. Make sure your food is cooked properly. Practice safe sex.

Relax. In some people with MS, stress can bring on flare-ups. Find calmness with meditation, yoga, counseling, or anything else that's good for you and helps you unwind. In one study, MS patients reported their stress level was cut nearly in half after 6 weeks of yoga.

Rest. You won't feel well when you're worn out. Sleep problems are common in people with MS. Symptoms like pain and muscle spasms can keep you up at night. Some of the meds that treat MS interrupt sleep, too. Work with your doctor to get your symptoms under control so you can sleep. Adjust your meds if they keep you awake. Aim for 7 to 8 hours of sleep per night.

Stay cool. High temps may trigger a flare-up. If you’re affected negatively by warm surroundings, you should skip saunas, hot tubs, and hot showers and baths. Most of the time hot weather causes fatigue. Also, do what you can to avoid being outdoors on hot days. Take cool baths and/or run air conditioning. Try a hat or clothes that hold ice packs or frozen gel packs to stay comfortable. If you have an exercise goal, divide the time you exercise into smaller segments, with rest after each one.

Eat well. Eat foods rich in omega-3 fatty acids. They’re believed to fight inflammation. Also, get plenty of fiber and stay away from foods with saturated and trans fats. A healthy diet helps keep your immune system strong.

Steer clear of smoking. This is a major risk factor for flare-ups, and it can make your symptoms worse. If you smoke, your doctor can help you make a plan to stop.

From: WebMD