About 80 percent of people with multiple sclerosis (MS) have varying degrees of spasticity. Like most other MS symptoms, spasticity is primarily caused by demyelination. Because of slow or interrupted nerve impulses, the muscles may do three things: not relax as quickly as they should, tighten involuntarily or stay contracted for longer periods of time -- or constantly. Several things will aggravate spasticity, acting as a “trigger” for spasms. These include:
- Infections, particularly urinary tract or bladder infections
- Pain
- Sores or skin breakdown
- An increase in internal temperature (i.e. because of a fever or excessive exercise)
- A full bladder
- Binding, rubbing or otherwise irritating clothes
- Constipation
- Problems with posture
- Stress, worry or anxiety
- Extreme environmental temperatures particularly cold weather
How do I manage Spasticity?
The management of spasticity is a balancing act that requires some skill. While drug treatments such as oral baclofen, tizanidine and benzodiazepines may reduce the spasticity and spasms, this is often at the cost of side effects such as sleepiness, dizziness, cognitive blunting, dizziness, dry mouth, constipation and increased weakness as your muscle tone is decreased. The general approach to management involves the following steps:
For more information about spasticity, click on the links below:
- Reduce or eliminate painful or noxious stimuli. This can include an area of skin breakdown or injury, a urinary tract infection, persistent urinary retention or constipation, among many possible causes
- Use a slow titration of a combination of medications to find the best response with the fewest side effects; the most common drugs to combine are baclofen and tizanidine. If spasticity or spasms remain a problem at night, add a benzodiazepine like diazepam at bedtime but avoid these medications during the day
- Physical modalities are important and should be used daily to reduce the effects of spasticity. This includes skillful stretching at least twice a day and possible functional electrical stimulation. These are useful modalities that require training by a skilled physical therapist with training in neuroscience; Yoga is also a beneficial physical modality to help reduce spasticity.
- If there is a specific muscle group causing problems with spasticity, such as the hip adductors or the small flexor muscles of the feet, treatment with botox injections is a great choice
- Those who spend most of their time in a wheelchair often benefit from an occupational therapy mobility evaluation to ensure that their seating is appropriate to reduce the effects of spasticity. Those no longer walking at all may benefit from a standing frame to obtain an upright posture several times a day
- Lastly, those with severe spasticity not responding to the above treatments usually benefit from an intrathecal baclofen pump (made by Medtonics). This is a programmable and refillable pump implanted under the skin in the abdomen (about the size of a hockey puck) with a catheter that is tunneled under the skin to deliver liquid baclofen directly to the spinal fluid. This deliver method is very effective and avoids most of the side effects associated with the use of oral baclofen pills.
For more information about spasticity, click on the links below:
|
|
|
PLEASE NOTE: The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
