Spasticity, one of the most common symptoms of MS, causes muscles to feel stiff and heavy, making movement difficult. It is a challenging MS symptom because it may or may not happen regularly, its manifestations can differ from person to person, and they can even differ in the same person at various times.
An estimated 60 to 90 percent of people with MS experience spasticity at some point.
Spasticity is an abnormal increase in muscle tone or stiffness that affects walking, balance and occasionally speech. It is caused by damage to nerve pathways that control movement. Spasticity in multiple sclerosis can range from mild stiffness to painful and severe muscle spasms — or sudden contractions — that are beyond a person’s control and can cause limbs to jerk.
Muscles anywhere can be affected, but those in the arms, legs, trunk, and back are most commonly affected by spasticity and spasms.
There are two types of spasticity. Flexor spasticity usually involves the muscles on the back of the upper leg, the hamstrings, and sometimes muscles at the top of the upper thigh, the hip flexors. In flexor spasticity, muscles involuntarily contract toward the chest, making it difficult for the hips and knees to straighten.
Extensor spasticity involves the muscles on the front and inside of the upper leg, the quadriceps and adductors. This kind of spasticity keeps the hips and knees straight, with the legs very close together or crossed at the ankles.
Sudden movements or position changes can aggravate spasticity in multiple sclerosis, along with extremes in temperature, humidity, infections, unsuitable clothing — such as tight shoes — and certain treatments. The condition is managed with medication, and physical and occupational therapy.
Treating spasticity in multiple sclerosis
The two most common medications for spasticity are baclofen and tizanidine. Baclofen, whose brand name is Lioresal, is a muscle relaxer that helps ease pressure on spinal-cord and upper-motor neurons. Intrathecal baclofen, which goes by the brand name Gablofen, is an option for severe spasticity that cannot be managed with oral baclofen. Tizanidine, whose brand name is Zanaflex, calms spasms and relaxes tightened muscles.
Another medication is diazepam, sold under the brand name Valium. It is used to relieve spasms that interfere with sleep.
Dantrolene — brand name Dantrium — is used only when other medicines are ineffective because it can cause serious liver toxicity and symptomatic hepatitis.
Levetiracetam, sold under the brand name Keppra, is an anticonvulsant medicine that can help ease spasticity and spasms.
Phenol is a neurolytic agent, which means that it acts on nerve conductors. It is used to treat severe MS spasticity when other treatment options have proven ineffective.
Injections of botulinum toxin, whose brand name is Botox, are administered about once in three months directly into affected muscles to treat stiffness. The treatment can be repeated after the effect has worn off, but no sooner than three months following the previous injection.
Regular exercise like stretching, undertaken after consultation with a physician or physical therapist, can also ease spasticity. Yoga, and relaxation techniques like meditation and deep-breathing exercises, can also be beneficial, as can massage. All of these should be done under a professional’s recommendation to meet individual patient needs.
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