Muscle spasms are defined as sudden, sustained and involuntary contractions of muscles and are common among people with MS.
They emerge as a result of nerve lesions that disrupt the signals between the brain and the muscle, causing the muscle to remain in a contracted state, making it tight or stiff. This muscle stiffness, also called spasticity, makes muscle movement difficult. The most commonly affected muscles are those of the legs, arms, back, and trunk.
Muscle spasms in MS may sometimes be accompanied with pain, weakness, and clonus (repetitive, involuntary up and down movements of a muscle). The most common clonus in MS is the tapping movement of the foot on the floor.
Muscle spasms are of various types depending on the type of muscle they affect. These are flexor spasms, extensor spasms, adductor spasms and back/trunk spasms. Flexor spasms cause a limb to bend, extensor spasms cause a limb to extend, adductor spasms cause a limb to point inwards, and back/trunk spasms cause the back to arch away from the chair.
Active movements, stretching, physiotherapy, and managing good posture are some of the strategies that may relieve muscle spasms.
Guidelines from the U.K. National Institute for Health and Care Excellence (NICE) suggest a number of medications that may be used to treat spasticity in MS. According to the guidelines, baclofen should be the first choice of treatment. If this drug does not work, other muscle relaxants may be used.
Please see below for a list of muscle relaxants that are used to treat muscle spasms and spasticity in MS.
Lioresal (baclofen) is an orally-available muscle relaxant that relieves muscle spasms and pain by acting on the central nervous system (CNS, the brain and spinal cord). Side effects include sleepiness, weakness, and imbalance.
Baclofen, intrathecal is the injected form of baclofen. It is injected into the intrathecal space, or the spinal canal. It acts on the CNS and relaxes muscle spasms and tightness, and is used to treat severe spasms that are untreatable by high oral doses of baclofen. The drug is injected with the help of a pump and a tube that are embedded beneath the skin of the stomach.
Zanaflex (tizanidine) is a muscle relaxant that slows the activity of the CNS to instantly relieve muscle spasms and increase muscle tone. It may cause dry mouth, sedation, and low blood pressure.
Other less commonly used medications for muscle spasms are listed below:
Valium (diazepam) is an extended-release benzodiazepine tablet. It is a CNS depressant that is used to relieve anxiety, muscle spasms, and seizures. It is sedating and may cause dependence.
Dantrium (dantrolene) is an oral, FDA-approved muscle relaxant that relieves chronic muscle spasticity in MS. Side effects include drowsiness, fatigue, and weakness. It can cause serious side effects such as liver damage and blood abnormalities, so it is only used if other medications do not work.
Klonopin (clonazepam), a benzodiazepine, is a CNS-depressant that decreases the abnormal brain signaling. It is recommended only if other medications do not work. Side effects include problems with coordination, drowsiness, depression, and fatigue.
Nydrazid/Laniazid (isoniazid), an antibiotic for tuberculosis treatment, is used to treat MS tremors. Side effects include nausea, vomiting, and numbness and burning pain in the hands and feet.
Botox (botulinum toxin A) is an FDA-approved neurotoxin that is used to relieve muscle spasms. It disrupts the signaling between the nerves and the muscles, resulting in temporary muscle relaxation that lasts up to three months.
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