Symtom Awareness
Spasticity
Causes and Effects
Spasticity is a common symptom of MS. Caused by demyelination along the nerves
that control muscle tone, spasticity is a tightening of the muscles. With MS,
spasticity most frequently occurs in the different muscles of the legs, buttocks,
back, and arms.
For some, spasticity can be mild, causing no real discomfort or inconvenience. Mild spasticity even provides some benefits, such as helping to prevent blood clots, improving circulation, and maintaining muscle tone. Muscle stiffness can provide added support while an individual is standing, walking, or transferring from one spot to another.
Unfortunately, many individuals with MS experience moderate to severe spasticity. This can be a debilitating symptom, which can greatly limit movement, use up valuable energy, and become quite painful. Another form of spasticity occurs in episodes, often at night. These are unexpected, involuntary movements of the leg (or sometimes the arm) where the limb suddenly draws up into a clenched position, or kicks out into an extended position.
Spasticity can lead to contractures as well. This occurs when the tendons become tight and the joint becomes difficult to move or even locked in one position. In addition to pain and immobility, complications of contractures include an increased risk of pressure sores and pneumonia.
Therapies and Devices
The
good news for those who suffer from moderate to severe spasticity is that
a number of effective treatments are
available. A team approach, including physicians, nurses, therapists, and
family members, is the best way to care for someone in need of treatment,
to ensure that all aspects of the person’s care are being addressed.
Treatment begins by regularly seeking and resolving any other health conditions that may aggravate or intensify spasticity and its painful effects. These conditions can include infections, as well as anything worn that doesn’t fit properly, such as a brace, cast, or tight clothing.
The next lines of treatment are stretching exercise and physical therapy. Stretching exercise can be very effective in relieving symptoms of spasticity, and these are typically performed while sitting or lying down, allowing gravity to assist with the stretching. A physical therapist can create a customized exercise program for an individual to perform daily at his or her home.
Devices or mechanical aids are another type of treatment to relieve spasticity and reduce the risk of contractures. The physical therapist can design a custom brace, splint, toe and finger spreader, or other device to hold an affected area in position. Contractures are sometimes treated through a series of casts which progressively stretch the tendons around a joint to promote greater movement.
Medications and Other Options
Several medications are available to treat spasticity as well. The most commonly
prescribed drug for spasticity in MS is oral baclofen. This drug works
well for a number of people, but dose must be carefully
monitored. Too little of this drug can prove to be ineffective, while too
much causes muscle weakness, fatigue, and confusion. Drowsiness and nausea
are other side effects of this medication. Baclofen may not be abruptly discontinued
as serious problems such as seizures may result.
Tizanidine (Zanaflex®) is another drug frequently prescribed for spasticity.
Dose titration is important to reduce sedation. The combination of baclofen and
tizanidine is feasible if done cautiously to avoid side effects. Several other
drug options are available to treat spasticity and spasms (please call MSAA’s
Helpline at (800) 532-7667 for a full listing), and some are given specifically
for nighttime spasticity or spasms, such as anti-epileptic drugs.
Other options for treating spasticity can include botulinum toxin A (Botox®)
injections (a temporary and expensive therapy limited to treating small areas
such as the face or eye), and more severe procedures such as blocking the nerve
permanently through injecting phenol into a muscle or by surgically cutting the
nerve. These latter treatments produce flaccidity, which is a significantly loose
muscle. While these procedures reduce or eliminate spasticity, spasms, and pain,
they do not increase mobility and also carry risks.
The Baclofen Pump
Often referred to as the baclofen pump, Intrathecal Baclofen Therapy (ITB™ Therapy)
is a successful treatment option
for many individuals with severe spasticity who are not responding well to
other therapies or having side effects. This therapy uses a surgically implanted
pump and a thin flexible tube to automatically deliver small doses of liquid
baclofen directly into the spinal fluid. This treatment has a powerful effect
on spasticity, particularly reducing severe muscle tone.
One advantage to using this system is that it delivers the medication directly
to where it will be the most effective, into the spinal fluid that bathes
the affected nerves. With oral baclofen, the medicine goes into the blood
system.
Another benefit to ITB Therapy is that a much smaller amount of medication is needed to produce results. The average dose is about 1/100th (one one-hundredth) of the oral dose. Most of the medication by-passes the blood system, so individuals do not normally experience side effects like muscle weakness, drowsiness, confusion, nausea, and vomiting, as some do with oral medications. Anyone allergic to baclofen or prone to infection is not a candidate for the baclofen pump.
The pump is implanted just under the skin of the abdomen, and the thin tube called a catheter is threaded back to the spine and into the spinal cord fluid. The pump is computer programmed according to the individual’s activities and symptoms, so various doses may be given throughout the day and/or night.
Individuals with MS who are suffering from severe spasticity will often experience a significant improvement after receiving a baclofen pump. As tight muscles relax, movement is restored and pain may subside. While an individual will not gain back lost function resulting from demyelination, he or she will get back any ability that was prevented due to spasticity. Moving, walking, transferring, activities of daily living, sleeping, and personal care can all be dramatically improved if spasticity has been the problem. For some, it can mean a return to his or her normal routine and lifestyle.
ITB™ Therapy is available through Medtronic®, Inc. As with any surgical procedure, some risks are involved that need to be considered before making a decision. For more information, talk to a doctor and visit Medtronic’s website at www.spasticity.com, or contact Medtronic by calling (800) 328-0810.
Please note that MSAA does not endorse or recommend any specific product, medication, or procedure. All details given are for informational purposes only; all decisions regarding changes in treatment should be made under the guidance of a qualified physician. For more information about spasticity, or for a list of references used for this article, please contact MSAA’s Helpline by calling (800) 532-7667.
