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Muscle spasticity is a condition that causes muscles to stiffen and tighten, disrupting normal fluid movement. It is a symptom of certain neurological conditions, such as cerebral palsy, multiple sclerosis, brain injuries, and spinal cord injuries. Spasticity can affect movement, speech, and gait, and can range from mild stiffness to painful and uncontrollable spasms. Treatment options include physical therapy, medication, and botulinum toxin (Botox®) injections. In more severe cases, surgical treatments such as selective dorsal rhizotomy (SDR) or intrathecal baclofen (ITB) therapy may be considered. Early treatment is important to prevent complications and improve quality of life.
| Characteristics | Values |
|---|---|
| Botox injections | Can be used to paralyze the spastic muscle, preventing it from contracting |
| Oral medications | Used in combination with other therapies or medications, such as physical or occupational therapy |
| Surgery | Used to treat tendon release or to sever the nerve-muscle pathway when medications and physical therapy don't improve symptoms |
| Physical therapy | Includes stretching exercises and reciprocal exercises |
| Splinting or bracing | Prevents involuntary spasms and reduces tightening of the muscles |
| Casting | Used to prevent muscles from becoming too tight |
| Cooling | May help to decrease muscle co-ordination in spasticity |
| Electrical stimulation | May decrease muscle tightness |
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Botox injections
It is important to note that Botox injections for spasticity should only be administered by a doctor or a certified medical professional specializing in Botox therapy for spasticity. The procedure involves multiple needle injections, and efforts are made to minimize anxiety and discomfort for the patient. Improvement is usually seen within 1 to 2 weeks after injection, with maximum results achieved between 3 to 4 weeks. The effects typically last for about 2 to 4 months, after which patients may require additional treatments.
While Botox therapy has been shown to be effective, it is not without potential risks and side effects. Serious allergic reactions have been reported, and patients with pre-existing breathing or swallowing difficulties may be at higher risk for complications. It is crucial for individuals considering Botox injections to discuss their medical history and any concerns with their doctor to ensure a safe procedure.
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Physical therapy
Spasticity is a condition in which muscles stiffen, tighten, or contract involuntarily, disrupting normal fluid movement and causing resistance to movement. It is caused by damage to the brain and spinal cord, and can be further triggered by a disorder or trauma, such as a tumour, stroke, cerebral palsy, or a spinal cord, brain, or peripheral nerve injury. As there is no cure for spasticity, the goal of physical therapy is to reduce spasticity as much as possible to prevent joint contractures and help the person live more independently.
Physical therapists may also use other modalities to reduce muscle tension and alleviate pain, such as moist heat, electrical stimulation, low-level laser therapy, and cryotherapy. Working to strengthen the antagonist muscle group—muscles that perform the opposite movement of the muscle that is spastic—can also help to improve joint mobility and function. Physical therapy can also be used in conjunction with other treatments for spasticity, such as oral medication, injections, splinting, or casting.
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Oral medication
- Baclofen, which restricts the influx of calcium into neural receptors and increases the influx of potassium, causing a decrease in the number of messages nerve cells transmit. It is the preferred drug for spasticity related to spinal cord injury or multiple sclerosis.
- Diazepam, which depresses the central nervous system.
- Dantrolene sodium, which reduces the release of calcium that usually occurs after muscle action. This medication is unique because it affects muscle fibre rather than nerve fibre. It is the only oral antispasticity medication approved by the US Food and Drug Administration.
- Tizanidine, which prevents the release of glutamate and aspartate, two amino acids that can excite nerve cells. It is often used in conjunction with other oral drugs, such as baclofen, for additive effects.
Other oral medications include gabapentin, which is prescribed when patients describe symptoms that are consistent with neuropathic pain along with spasticity. Clonidine is another oral medication that stimulates alpha-2 adrenoreceptors in the brainstem, resulting in reduced sympathetic outflow.
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Splinting or bracing
There are various types of splints available for treating spasticity, including static and dynamic splints. Static splinting can help to reduce spasticity and improve hand function and functional task performance. Dynamic splinting can increase hand function and is especially useful for improving the range of motion in the affected area.
Ankle contracture boots are another type of splint used to hold the foot and ankle in a static stretch, which can be adjusted as needed. Ankle-foot orthoses (AFOs) are the most commonly used type of splint for spasticity. They can be stock or custom-made and can include an ankle joint if required. AFOs enable the foot and ankle to be held in the correct position and can have spasticity-reducing footplates built into them. Elbow gaiters are also used to improve function by maintaining the extension of the arm.
The process of receiving a splint typically involves an assessment of the patient's requirements, needs, and level of spasticity. Based on this information, appropriate splint suggestions are made, and the patient is measured and cast if necessary. The details are then sent to the manufacturer, and the patient attends a fitting where they are taught how to wear and use the splint correctly. It is important to consult a healthcare professional before using a brace or splint, as prolonged use can weaken the muscle and cause joint stiffness. Monitoring by a medical professional is crucial to ensure proper use and fit, as improper use or an incorrect fit can cause additional damage.
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Surgery
Surgical Options
There are several surgical options for reducing spasticity, which are generally employed when less invasive procedures have not been successful. These include:
- Selective Dorsal Rhizotomy (SDR): This procedure is used to treat severe spasticity in the legs, and is most often performed on people with cerebral palsy. It involves cutting the problematic nerve roots that cause an imbalance of electrical signals to certain muscles. This can reduce muscle stiffness while maintaining other functions. The candidate nerve rootlets are stimulated electrically, and those that produce abnormal responses are cut.
- Intrathecal Baclofen (ITB) Therapy: This treatment involves surgically placing a pump in the abdomen that releases a steady dose of the medication baclofen directly into the spinal fluid through a catheter. This can significantly reduce spasticity and pain, with a lower risk of drowsiness compared to taking baclofen orally.
- Orthopaedic Surgery: Orthopaedic surgery deals with the consequences of spasticity on muscles, bones, and connective tissue. For example, contracture release is a common procedure to lengthen the Achilles tendon, correcting "equinus" deformity. Other targets include contractures in the knees, hips, shoulders, elbows, and wrists.
Considerations
When considering surgery for spasticity, it is important to keep in mind that none of the surgical approaches completely eliminate spasticity. Oral medications are often used first, but they can have adverse effects, especially in children, due to their impact on learning and development. Surgery is generally more successful when performed by a team of specialists, including pediatric neurosurgeons, neurologists, anesthesiologists, orthopaedic surgeons, and physiatrists. Intensive physical therapy after surgery is also important for a positive outcome.
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Frequently asked questions
Muscle spasticity is a condition in which muscles stiffen or tighten, preventing normal fluid movement. It is caused by damage to the nerve pathways that control muscle movement. It can be triggered when changing position or moving suddenly.
Symptoms include continuous muscle stiffness, spasms and involuntary contractions, which can be painful. It can also lead to frozen joints and pressure sores on the skin.
Treatment options for muscle spasticity include physical therapy, medication, surgery, and botulinum toxin (Botox) injections. It is important to seek medical advice for a proper diagnosis and treatment plan.
Some home-care treatments to help ease the symptoms of muscle spasticity include stretching exercises, changing positions often, splinting or bracing, and electrical stimulation.
