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spasticity

 

Spasticity is involuntary muscle contractions that are not coordinated with other muscles. Most muscles in the human body come in pairs that work in opposite ways to eachother. When one is contracted, the other is stretched. The biceps and triceps are two such muscle pairs. When you stretch your forearm out, the triceps is contracted and the biceps stretched - when you pull it in, the reverse happens. The regulation of the two muscles is a complex, finely controlled and delicate mechanism which involves sending information to the muscles and receiving sensory feedback from them. In spasticity, the system gets things wrong and contracts both at the same time.

Spasticity can be very painful and, depending on the affected muscles, can result in an uncoordinated gait, stiff or deformed posture and shortening of the range of limb movement. It can cause permanent muscle shortening and problems around the joints against which the two spastic muscles are supposed to move (contracture). It can be a permanent feature or brought on by a variety of factors such as fatigue, heat or infection.

Spasticity is a common in a number of conditions including cerebral palsy, spinal cord injury, stroke and multiple sclerosis.

In multiple sclerosis, spasticity is usually caused by damage to the nerves (neurons) that control muscles or those that collect sensory information back from them. Reflexive spasms which are generated by the spinal cord are not inhibited by the brain, as normal, and increased muscle tone results. The lesions responsible are usually in the cerebellum or the white matter tracts that connect it to the peripheral motor (efferent) and sensory (afferent) nerves.

Spasticity is a very common problem in MS. It often affects the legs although it can effect almost any muscle pair in the body. Clonus (repetitive muscle spasms) is often associated it.

The upside to spasticity is that the increased muscle tone often prevents the muscular atrophy that can occur through lack of use.

The first line of treatment for spasticity is physical therapy which can involve strengthening and stretching exercises and other non-invasive procedures. If these are effective or the spasticity is mild, drug treatments are often undesirable.

Direct drug treatments for spasticity include:

A number of drug treatments are also available to address the pain the results from spasticity.

Many people report that cannabis works both for the muscle spasms and the pain involved with spasticity.

Very radical treatments are sometimes used for very severe spasticity and involve the destruction of nerves or muscles:

Spasticity links:
We Move - Spasticity
Spasticity: Innovations in Treatment
Cannabinoids might reduce spasticity in multiple sclerosis
Treatment of Spasticity in Multiple Sclerosis with Magnetic Stimulation
Anti-spasticity agents for multiple sclerosis (Cochrane Review)
MS Glossary
All About Multiple Sclerosis