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Spasticity
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What is spasticity?
Spasticity refers to involuntary muscle spasms or stiffness. It is a common symptom of MS. Normally one set of muscles contracts while another set relaxes. With MS this coordinated movement may be lost because of the change in the way nerve impulses flow. Although it may occur in the arms, it usually affects the leg muscles.

What does spasticity feel like?
Spasticity can range from a twinge of muscle tightness to a painful muscle contraction which affects mobility. It can lead to a lack of coordination or a feeling of clumsiness. The extra effort needed to move can lead to increased fatigue. Some muscle spasms come and go especially at night.

What contributes to spasticity?
An increase in spasticity can be the result of an exacerbation (sudden worsening of an MS symptom or symptoms or appearance of new symptoms), infection, constipation, extreme temperature changes or skin changes (e.g. ingrown toenail, pressure sore). Spasticity can even be triggered by stress, anxiety or something as simple as tight clothing.

Are there serious complications associated with spasticity?
A contracture is a frozen or immobilized joint that can result from severe spasticity. Pressure sores can also occur when movement is difficult or limited. When these complications go untreated, spasticity increases and a negative cycle begins.

How is spasticity treated?
Treatments for spasticity can include exercise, physical therapy, mechanical devices, medications or surgery. First, you want to eliminate any contributing factors. For example, speak with your doctor to treat a possible bladder infection or constipation, maintain good skin care or avoid temperature extremes.

An exercise program that includes stretching and range of motion can be very beneficial. A physical therapist can get you started on a home program.

Mechanical (orthotic) devices can assist with mobility and achieve more comfortable positioning. Braces or splints should be fitted by a professional. For example, an ankle-foot orthosis (AFO) is a common brace prescribed to keep your foot and ankle stable to help with walking or preventing a contracture.

What medications are used to treat spasticity?
There are two medications commonly prescribed to treat spasticity. Neither medication will cure spasticity or increase strength.

• Baclofen (Lioresal) is a muscle relaxer that works at the level of the spinal cord. The proper dose for each person is achieved by increasing the amount of medication slowly until you achieve maximum benefit with minimal side effects. The most common side effects are drowsiness and muscle weakness. You should never stop baclofen suddenly without speaking to your doctor.
•Tizanidine (Zanaflex) is another common muscle relaxer that calms spasms. Dosing is increased slowly and the most common side effect is drowsiness. Low blood pressure is another possible side effect. There are two forms of this drug (capsules and tablets). Speak with your doctor about the best choice for you. Sometimes Baclofen and Tizanidine are used together. Timing of the drugs can be important so talk with your doctor about your specific needs.
•Botulinum toxin (Botox) is an injection into the affected muscles that has shown to help with spasticity. The treatments must be repeated every three to six months and it is not yet approved by the FDA for MS-related spasticity despite its effectiveness.
•Intrathecal Baclofen Pump is another alternative for people with severe spasticity who cannot tolerate higher doses of baclofen. A small pump (about the size of a tuna fish can) is implanted under the skin in the abdomen. A computer controlled dose of baclofen is delivered to the spinal canal directly and continuously through a small tube (which is also under the skin and not visible).

Are there any surgeries available?
Surgical procedures are usually only done in extreme cases and include rhizotomy (cutting of the spinal nerve) or tenotomy (cutting tendons away from the muscle).