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Spasticity

[spas-tik]

Spasticity or muscular hypertonicity is a disorder of the body motor system, and especially the central nervous system (CNS), in which certain muscles continually receive a message to tighten. This causes stiffness or tightness of the muscles and may interfere with gait, movement, and speech.

Spasticity is most common in spastic diplegia and other forms of spastic cerebral palsy, but it also presents extensively in multiple sclerosis and to different degrees in most other neuromuscular conditions as well, both progressive and not.

Presentation

Symptoms may include hypertonia (increased muscle tone), clonus (a series of involuntary rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissor gait, and over time, shortened tendons and fixed joints (contractures). The degree of spasticity varies from mild muscle stiffness with minimal impact on function to severe and painful joint and muscle breakdown and uncontrollable muscle spasms.

The condition often interferes with daily activities. Over the years, it may increase in its effect, so more severe treatments may be needed later. Cold weather and fatigue can trigger spasms more severely than other times. The constant spasms can lead to muscle fatigue so periodic rest is required but often difficult to achieve. Multi-tasking (such as walking, talking, eating and other activities) can also trigger more severe spasticity.

Possible benefits

In patients with spastic cerebral palsy, a wider margin of neurosurgeons — due to observation of extensive and continually worsening joint, muscle and bone stress resulting from spasticity over decades of early life (20s, 30s, etc.), and the fact that such extreme pressure from the spasticity is not at all what the human body is meant to accommodate, thus automatically predisposing the spastic-muscled individual to very early-onset arthritis, joint deformities, hip pain, and other problems — are now reaching a consensus that there is, in fact and directly contrary to past convention, actually no positive overall benefit to spasticity in an individual at any stage of life — and moreover, if such spasticity can be neurosurgically eliminated, such as through a selective dorsal rhizotomy, it should be done as early in the life cycle as possible, preferably the pediatric period, to save the person from needing to deal with a lifetime of spastic movement.

However, in patients with multiple sclerosis or other neuromuscular conditions with a different basis than cerebral palsy (that is, conditions where the spasticity/weakness dynamic changes when the condition changes, which does not happen in CP), possible benefits of spasticity may indeed exist. Common arguments for benefits of spasticity to the function of a given person are that spasticity:

May help some patients to walk, stand or transfer (e.g., stand pivot transfers)
May assist in maintaining muscle bulk, i.e., in exercising the muscles, inherently preventing atrophy
May assist in preventing DVTs
May assist in preventing pressure ulcer formation over bony prominences
Can be used as “diagnostic tool” (with increased spasticity being a sign of exposure to a noxious stimuli—infection, bowel impaction, urinary retention, etc)

Treatment

Massage and stretching provide only temporary relief from spasticity, but for everyday management, some form of stretching must always be implemented by the spastic person. Stretching and strengthening exercises are also needed to prevent contractures.

Treatment may also include such medications as baclofen, diazepam, dantrolene, or clonazepam; surgery for tendon releases; or phenol to dampen the spastic signals between nerve and muscle or botox directly into the muscle. In spastic CP, selective dorsal rhizotomy may also be considered.

Some jurisdictions have also issued medical marijuana to help treat spasticity.

Prognosis

The prognosis for those with spasticity depends on the severity of the spasticity and the associated disorder(s). To a small degree spasticity performs the helpful role of exercise, but it is usually bothersome to normal activities in life.

References

"Other Complications of Spinal Cord Injury: Spasticity." (Louis Calder Memorial Library of the University of Miami/Jackson Memorial Medical Center, October 3, 2002), http://calder.med.miami.edu/pointis/spasticity.html

Maureen E. Neistadt and Elizabeth Blesedell Crepeau, ed. (1998). Willard and Spackman's occupational therapy. Philadelphia: Lippincott-Raven Publishers.