Spasticity
Spasticity involves involuntary muscle stiffness and/or spasms-sustained muscle contractions or sudden movements.
It is one of the more common symptoms of MS.Spasticity can be as mild as the feeling of tightness of muscles or so severe as to produce painful uncontrollable spasms of extremities, usually of the legs. Spasticity can also produce feelings of pain or tightness in and around joints and can also cause low back pain.Some people whose legs are very weak, find that spasticity makes the legs more rigid and actually helps them to stand, transfer, or walk.
There are two types of severe MS-related spasticity:
- In flexor spasticity, mostly involving the hamstrings (muscles on the back of the upper leg), the hips and knees are bent.
- In extensor spasticity, involving the quadriceps (muscles on the front of the upper leg), the hips and knees remain straight, with the legs very close together or crossed over at the ankles. Spasticity can also occur in the arms, but is less common.
Spasticity may be aggravated by extremes of temperature, humidity, or infections. It can even be triggered by tight clothing.
Can Be Treated With Exercise and Medication
There are a number of therapeutic approaches to the management of spasticity. Because spasticity varies so much from person to person, it must be treated on an individual basis and demands a true partnership between the person with MS, physician, nurse, physical therapist and occupational therapist. Treatment begins with the physician recommending ways to relieve the symptoms. These could include medication, exercise, changes in daily activities, or combinations of these methods. The physician will track the progress and make referrals to other health professionals such as occupational and physical therapists. Daily stretching and other exercises are often effective in relieving spasticity.
If medication is needed, there is one major antispasticity drug:
- Baclofen (Lioresal®) is the most commonly used drug. It is a muscle relaxant that works on nerves in the spinal cord. Common side effects are drowsiness and a feeling of muscle weakness. It can be administered orally or by an implanted pump. This method is called intrathecal baclofen and is used only for spasticity that cannot be managed by oral medication.
Baclofen has a good safety record. However, it cannot cure spasticity or improve muscle coordination or strength.
Other drugs less commonly used are:
- diazepam (Valium®) this is not a "first choice" drug for spasticity because it is sedating and has a potential to create dependence. However, its effects last longer than baclofen and physicians may prescribe small doses of Valium® at bedtime to relieve spasms that interfere with sleep.
- dantrolene (Dantrium®), is generally used only if other drugs have not been effective. It can produce serious side effects including liver damage and blood abnormalities.
- phenol, a nerve block agent.
- botulinum toxin and clonidine, still considered experimental.
Source - The MS Information Sourcebook produced by the Information Resource Center and Library of the National Multiple Sclerosis Society. © 2001 The National Multiple Sclerosis Society. All rights reserved. Reproduced with permission.
