Spasticity - Underlying Causes, Symptoms, Diagnosis, and Treatment Plans

What Is Spasticity?

It is a condition where muscles contract or tighten against the will when one tries to move them. It is caused by damage to the nerves in the central nervous system (brain and spinal cord), which interrupts the normal pattern of reflexes, thereby affecting muscle contraction. Muscles go tight and rigid with an increase in muscle tone and stiffness. This condition often affects the legs but can also occur in the arms and neck, and trunk region. Spasticity should be treated, as it causes pain and discomfort. Additionally, it interferes with the activities of daily living, sleep, and affects one’s ability to function.

What Are the Different Types of Spasticity?

There are two types of spasticity:

1. Diffused Spasticity - Involving many muscles in the body.

2. Focal Spasticity - Involves only a single group of muscles.

What Are the Causes of Spasticity?

The most common cause of spasticity is stroke. Muscles go stiff and rigid in a post-stroke individual and contract involuntarily when one tries to move them. The commonly affected parts are the elbows, wrists, and fingers. The muscle is unable to complete its full range of motion. This impairs one’s walking, speech, movements, and many other activities of daily living. Spasticity occurs in certain conditions that affect the brain and spinal cord, including:

• Cerebral palsy.

• Traumatic brain injury.

• Brain damage due to lack of adequate oxygen supply.

• Stroke.

• Spinal cord injury.

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• Multiple sclerosis or amyotrophic lateral sclerosis.

• Conditions like phenylketonuria, adrenoleukodystrophy, or Krabbe’s disease.

• Spasms are triggered even by extreme temperatures, high humidity, fatigue, stress, and infections.

What Are the Specific Symptoms of Spasticity?

The most common symptom is the resistance felt on trying to stretch a joint angle. The symptoms of spasticity include:

1. Increased muscle tone (hypertonia).

2. Involuntary movements such as spasms, involuntary muscle contractions, and a series of fast, involuntary contractions that feel like tremors (clonus).

3. Permanent tightening of the muscles and tendons due to severe stiffness and spasms (contracture).

4. Pain or discomfort.

5. Speech disability.

6. Lesser ability to function.

7. Problems with personal care and hygiene routines.

8. Abnormal posture.

9. Deformity of the affected area.

10. Tends to hold the arm, wrist, and fingers at an abnormal angle.

11. Scissoring or crossing at the tip of the feet.

12. Twisted hips.

13. Bone and joint deformities.

14. Reduced quality of life.

15. With prolonged spasticity, one may suffer from frozen joints and pressure sores.

What Tests Are Used to Diagnose Spasticity?

To make a diagnosis of spasticity, the doctor will perform a physical examination and ask the individual about his or her medical history. Next, analyze the patient’s posture, movements, coordination, and strength. As a part of this analysis, the doctor will stretch various muscles to assess how tight they are. For instance, a strong and exaggerated knee-jerk reflex can be indicative of spasticity. One may order many tests to understand the underlying cause of spasticity, such as:

• Imaging studies like computed tomography (CT) scan or magnetic resonance imaging (MRI) to look for damage in the central nervous system.

• An electromyography procedure to evaluate the electrical activity of the nerve connected to the concerned group of muscles.

What Is the Treatment for Spasticity?

In most individuals, the cause of spasticity is already known, and the goal of the assessment is to determine how best to minimize its impact. The treatment plan is developed based on the patient’s needs, preferences, and goals. For the best treatment outcomes, one requires active involvement from the patient, support person, or caregiver who can work with a team of health care professionals from different specialties.

Members of this team may include a neurologist, physiatrist, rehabilitation doctor, physician assistant, nurse practitioner, physical therapist, occupational therapist, speech and language pathologist, neurosurgeon, and orthopedic surgeon. Spasticity can be treated in various ways, both nonmedically and medically. The effects of spasticity can be reduced in the following ways:

1. Performing stretching exercises daily. Prolonged stretching can elongate the muscles. This helps decrease spasticity and prevents the tightening of muscles. Performing an adapted exercise routine as often as possible helps with maintaining the range of motion and flexibility.

2. One can make use of splints, casts, and braces for additional support.

3. Spasticity can also be treated with oral medications, which include Baclofen, Tizanidine, Dantrolene sodium, Diazepam, Clonazepam, and Gabapentine. They help to relax a large number of muscles with specific doses.

4. Botulinum toxin injections such as Botox, Dysport, Xeomin, and Myobloc - Botulinum toxin can be injected directly into the spastic muscles. They can reduce tone selectivity in muscles where spasticity is the most bothersome. It is particularly effective with focal spasticity. They are safe and well-tolerated by the majority of individuals. It takes around seven to ten days to show effects and lasts for about three months.

5. Baclofen pump - Intrathecal Baclofen is used to treat severe diffuse spasticity. After a thorough screening, the medication is delivered directly into the spinal fluid by a surgically implanted programmable pump and catheter. Because the drug is delivered close to the spinal cord, much less Baclofen is needed to achieve muscle relaxation, and the side effects are fewer compared to drugs taken by mouth.

6. Surgery is performed in some individuals to release a tendon or free the connection between the nerve and the affected muscle.

7. The pain associated with spasticity is alleviated with muscle relaxants, sedatives, and nerve blockers, like Phenol.

8. There are few home treatments the affected individual can try to relieve the symptoms. One should not get exposed to extreme heat and cold weather and get plenty of sleep. Make sure to change positions now and then and also exercise frequently.

Conclusion:

One should seek medical help if the spasticity is getting more painful and starts to affect day-to-day life. Although managing the symptoms of spasticity does not treat the underlying condition, it can improve the patient’s comfort and range of motion. It can also take care of the individual’s life and make it easier. And in some cases, it can improve the patient’s ability to perform daily activities. With the help of a qualified medical practitioner, one can do the needful to improve the quality of life.