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UK Charity No 1131517
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UK Charity
No 1131517
Multiple Sclerosis
It is important to remember that MS is only one part of a person and not the person.
MS does not represent them, it is not their identity, they are as normal as the next person.
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Spasticity
Regulation and control of muscle movement / stimulation is a complex, and finely controlled sensitive mechanism which involves the brain sending information to the muscles and receiving sensory feedback from them. When this sensory system is disrupted, as in the case of MS, it becomes disorganised then spasms and spasticity occur. The symptoms of spasticity are painful involuntary contractions of muscles, sometimes causing the legs to kick out or flex in. When severe, limbs can go into involuntary rhythmic contractions (clonus) when put in certain positions.
It can also refer to a wide range of involuntary muscle spasms. It may also produce feelings of discomfort, pain or tightness in and around joints, as well as low back pain. Spasticity can occur in any limb; however it is much more common in the legs.
While many people with MS develop some degree of spasticity, those with severe MS are more likely to experience spasticity that limits their ability to undertake simple every day tasks and therefore affects their quality of life.
Quality of life can be affected through troublesome symptoms and functional limitations. severe spasticity may even lead to medical complications such as skin breakdown or contractures. Left untreated; contractures can lead to serious complications, such as, frozen or immobilized joints and pressure sores. These elements underscore the need to recognise and address spasticity and its consequences.
‘Severe contractures may result in people spending most of their time in bed’.
Spasticity, which refers mainly to feelings of muscle stiffness and involuntary muscle
spasms, is a well defined consequence of MS. It can be identified and assessed, for
the most part, based on reported symptoms and findings on clinical examination and
without sophisticated tests. Clinical practice guidelines for the management of spasticity
in MS were published in 2003 by the Consortium of MS Centres, however spasticity
may remain under-
There are published data demonstrating that spasticity occurs frequently in people with MS. In a large survey of more than 30,000 people, by the North American Consortium of Multiple Sclerosis (NARCOMS) Registry, 84% of the people surveyed reported that they had spasticity. Male gender, older age, and longer duration of the disease were associated with an increased severity of spasticity. The level of spasticity also correlated with the level of disability related to MS.
It is sometimes difficult to identify spasticity among other symptoms. For example, a sensation of stiffness in the legs may result from spasticity, but also from abnormal sensations or from the weakness associated with MS. The presentation and severity of spasticity varies among people with MS and in the individual over time. A consequence of spasticity constantly fluctuating and evolving, is that any treatment or rehabilitation plan must be adapted to the differing stages that are unique to every individual.
For many initial interventions such as stretching, exercise and rehabilitation are helpful. This may also enhance the potential efficacy of other interventions such as medication, particularly when functional improvement is sought.
Spasticity can impact on:
- Mobility.
- Dexterity.
- Bladder management.
- Sexuality.
- Hygiene.
- Sleep.
- Comfort.
- Posture.
- Spasticity is both painful and uncomfortable, and can make it difficult to transfer or handle a person.
The affected muscles can cause an uncoordinated gait, stiff or deformed posture and a shortening of the range of limb movement, this situation can become a permanent feature or brought on by a variety of factors such as:
- Fatigue.
- Heat.
- Humidity.
- Infection.
- Stress
- Sudden movements or position changes.
One of the main complications of severe spasticity is a fixed shortening of the affected muscle, leading to a reduced range of movements in the limb. Severe contractures may result in people spending most of their time in bed. Left untreated; contractures can lead to serious complications, such as, frozen or immobilized joints and pressure sores.
Medications
- Baclofen -
Lioresal is a muscle relaxant that works on nerves in the spinal cord. Common side effects are drowsiness and a feeling of muscle weakness. This is used for severe spasticity that cannot be managed with oral medication. - Tizanidine -
Zanaflex Works to calm spasms and relax tightened muscles. - Diazepam -
Valium. small doses of Valium may be prescribed at bedtime to relieve spasms that interfere with sleep. - Dantrolene -
Dantrium . This is generally used only if other drugs have not been effective (can produce adverse side effects) - Phenol -
Is a nerve block agent - Botulinum Toxin -
Botox shown to be effective in relieving spasticity in individual muscles for up to three months. - Clonidine -
considered experimental, appears to relieve spasticity
Management
Spasticity should be treated on an individual basis by a personal physiotherapist
whether it is as a referral from a Neurologist to a hospital physiotherapy department,
or, self-
Treatment begins with the physiotherapist assessing the degree of spasticity followed by recommending ways to relieve the symptoms, including exercise, medication, changes in daily activities, or combinations of these methods. Daily stretching and exercise can be quite helpful in helping to relieve spasticity.
Clonus -
Contracture -
- Spastic cerebral palsy.
- Multiple Sclerosis.
Contractures can't be stretched or exercised away once they occur; they may, in some cases require an orthopaedic surgical intervention to be corrected.
