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Spasticity is a neurological condition that causes an abnormal increase in muscle tone or stiffness, which can impair bodily functions and daily activities. The severity of spasticity varies from mild stiffness to severe, painful, and uncontrollable muscle spasms. The condition is caused by damage to nerve pathways within the central nervous system, which disrupts the balance of signals from the brain and spinal cord to the muscles. This damage can be a result of degenerative diseases, physical injuries, or infections that affect the brain or spinal cord. Treatments for spasticity include medications, physical therapy, and local injections of Botox or Dysport. Understanding the underlying causes of spasticity is crucial for effective management and treatment of the condition.
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What You'll Learn
Damage to nerve pathways
Spasticity is a neurological condition characterised by an abnormal increase in muscle tone or stiffness, which can significantly impair bodily functions and daily activities. The condition is caused by an imbalance of signals from the central nervous system to the muscles. This imbalance can be caused by damage to nerve pathways within the central nervous system that control muscle movement.
Spinal cord injuries (SCI) are another cause of nerve pathway damage leading to spasticity. SCI involves damage to the spinal cord that disrupts its function, causing temporary or permanent changes that result in muscle overactivity. Multiple sclerosis (MS) is a condition where the myelin sheath, the protective covering of brain and spinal cord nerve fibres, is damaged. This impairs communication between the brain and muscles, leading to spasticity.
Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig's disease, is a progressive neurological disease that causes the death of neurons controlling voluntary muscles, resulting in spasticity. Cerebral palsy, a group of disorders affecting movement and coordination, originates from damage to the developing brain, typically before birth. In addition, infections such as meningitis or encephalitis can cause spasticity by inflaming or damaging areas of the brain or spinal cord that control muscle movements.
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Spinal cord injury
Muscle spasticity is a common complication of spinal cord injuries (SCI). It is caused by damage to the nerve pathways within the spinal cord that control movement and stretch reflexes. This damage disrupts the normal pattern of muscle movement, causing certain muscles to contract all at once, which can make voluntary movement difficult.
Spasticity typically develops around six weeks after a spinal cord injury. It may start as a small twitch or develop more fully, and it can affect any muscles controlled by the affected motor nerves. The symptoms of spasticity can vary, but in severe cases, it can cause extreme pain and interfere with daily functions, such as hygiene and basic care. It can also lead to contractures (frozen or immobilized joints), bone fractures, partial or full dislocation of joints, urinary tract infections, and chronic constipation.
There are various treatments available to manage spasticity after SCI. These include physical therapy, stretching, splints, braces, and ice. In some cases, doctors may prescribe medications such as Lioresal (baclofen) or Zanaflex (tizanidine), which can help to relax the muscles and reduce spasms. For more severe cases of spasticity, doctors may recommend selective dorsal rhizotomy (SDR), which involves surgically cutting carefully selected nerve roots to rebalance the electrical signals sent to the spinal cord. Another option is orthopaedic surgery, which treats the consequences of spasticity on muscles, bones, and connective tissue, such as contractures and deformities.
Additionally, doctors trained in Botox shots can use electromyography (EMG) to guide the injections to the proper muscle and reduce hyperactivity. In some cases, a pump may be surgically implanted near the abdomen to deliver medication directly to the spine, providing a steady dose of medication that can be more effective than oral drugs.
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Multiple sclerosis
Spasticity, muscle spasms, and stiffness are common symptoms of multiple sclerosis (MS). It typically occurs in the leg, groin, and buttock muscles, which help people to stand and balance in an upright position. Spasticity in MS is caused by demyelination along the nerves of the brain and spinal cord that control movement. This results in an imbalance in the electrical signals coming from the brain and spinal cord, causing muscles to contract and tense on their own.
Spasticity can manifest as stiffness that doesn't go away or as sudden uncontrolled movements, especially at night. It can feel like a muscle tightening, and it may be painful or ache. The severity of spasticity can vary depending on one's position, posture, and level of relaxation. It can also be influenced by external factors such as temperature, with spasticity worsening in very hot or cold conditions.
The impact of spasticity can range from mild to severe. In mild cases, spasticity may not cause pain and can even provide extra support for standing or turning. However, more severe spasticity can cause significant discomfort, limit movement, and affect one's quality of life, emotional health, relationships, and employment.
There are various treatments available to manage spasticity in MS. These include physical therapy, stretching exercises, aquatic therapy, orthotic devices, and medications such as muscle relaxants and baclofen.
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Stroke
Spasticity is a common post-stroke condition, affecting 25-43% of survivors in the first year after their stroke. It causes stiff or rigid muscles, which can make it difficult to move and carry out everyday tasks. Spasticity occurs when a muscle involuntarily contracts when you move, often affecting the elbow, wrist and ankle. This can cause the surrounding tendons and soft tissue to tighten, making it even more difficult to stretch the muscle.
A stroke can damage the part of the brain that controls the signals to the muscles. This can lead to muscles contracting for long periods or going into spasm, known as spasticity or hypertonia. Muscles with spasticity have increased tone and become very tight. Spasticity in the leg muscles can make it difficult to walk, affecting your balance and increasing your risk of falling. Spasticity in the arm can make it difficult to open your hand or reach for something. It can also cause a clenched fist, which can lead to skin breakdown and nail bed infections.
There is currently no cure for post-stroke spasticity, but treatments and lifestyle changes can help reduce symptoms and maintain your range of motion. Treatments include injections of botulinum toxin to block nerves and relax the muscles, oral medications, functional electrical stimulation, and physiotherapy. Physiotherapists will recommend exercises to lengthen and strengthen muscles, and may also recommend splints to help keep a good range of movement in your limbs.
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Brain or head trauma
Spasticity is a muscle control disorder characterised by tight or stiff muscles and an inability to control those muscles. It can result in mild stiffness or severe, painful, uncontrollable muscle spasms. It is caused by an imbalance of signals from the central nervous system to the muscles.
The onset of spasticity after a TBI is rapid, beginning as early as one week following injury. The progressively developing spasticity often represents a significant barrier for the practical re-entry of TBI patients into the community. The dynamic features of velocity-dependent exaggeration of lengthening resistance to the skeletal muscle remain. The different patterns of spasticity are presumed to be derived from the manner in which the central nervous system (CNS) trauma or disease has induced alterations in supraspinal drive.
Treatments for spasticity include medications such as muscle relaxants and antispastic agents, and occupational and physical therapy programs involving muscle stretching and range of motion exercises. Local injections of botulinum toxin have been shown to be more effective than oral medicines for many kinds of spasticity. Deep brain stimulation is being studied as a treatment when other measures fail to bring relief.
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Frequently asked questions
Spasticity is a neurological condition characterised by an abnormal increase in muscle tone or stiffness, which can affect bodily functions and daily activities. It is caused by an imbalance of signals from the central nervous system to the muscles.
Spasticity can be caused by damage to nerve pathways within the nervous system that control muscle movement. This damage can be caused by degenerative diseases, physical injury, or brain trauma.
Some common causes of nerve pathway damage that can lead to spasticity include spinal cord injuries, multiple sclerosis, cerebral palsy, stroke, and hereditary conditions such as hereditary spastic paraplegia (HSP).
Treatment for spasticity typically involves a combination of exercises, stretching, oral medications, and in some cases, botulinum toxin (Botox) injections into the affected muscles to reduce muscle signals that cause spasticity.
