Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 24-21: Spasticity + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ The term "spasticity" is commonly used for an upper motor neuron deficit, but it properly refers to an increase in resistance to passive movement that affects different muscles to a different extent +++ General Considerations ++ Spasticity is often a major complication of stroke, cerebral or spinal injury, static perinatal encephalopathy, and multiple sclerosis It may be exacerbated by pressure injuries (formerly pressure ulcers), urinary or other infections, and nociceptive stimuli + Clinical Findings Download Section PDF Listen +++ ++ A velocity-dependent increase in resistance to passive movement that affects different muscles to a different extent Not uniform in degree throughout the range of a particular movement Commonly associated with other features of pyramidal deficit + Diagnosis Download Section PDF Listen +++ ++ Clinical + Treatment Download Section PDF Listen +++ +++ Medications ++ Drug therapy is important, but it may increase functional disability when increased extensor tone is providing additional support for patients with weak legs Dantrolene Weakens muscle contraction by interfering with the role of calcium Best avoided in patients with poor respiratory function or severe myocardial disease Begin with 25 mg once daily orally, and increase by 25-mg increments every 3 days, depending on tolerance, to a maximum of 100 mg four times daily orally Side effects: diarrhea, nausea, weakness, hepatic dysfunction (which may rarely be fatal, especially in women older than age 35), drowsiness, light-headedness, hallucinations Baclofen An effective drug for treating spasticity of spinal origin and painful flexor (or extensor) spasms Initial dose is 5 or 10 mg twice daily orally and then built up gradually The maximum recommended dose is 80 mg once daily orally Side effects: gastrointestinal disturbances, lassitude, fatigue, sedation, unsteadiness, confusion, hallucinations Diazepam May modify spasticity by its action on spinal interneurons and perhaps also by influencing supraspinal centers Effective doses (2–10 mg three to four times daily orally) often cause intolerable drowsiness and vary with different patients Tizanidine is a centrally acting α2-adrenergic agonist As effective as these other agents but is probably better tolerated The daily dose is built up gradually from 4 mg once daily orally, usually to 8 mg three times daily orally Side effects: sedation, lassitude, hypotension, dryness of the mouth Cannabinoids are effective in reducing spasticity but are associated with side effects, including dizziness, drowsiness, and fatigue Intramuscular administration of botulinum toxin has been used to relax targeted muscles Intrathecal injection of phenol or alcohol may be helpful in severe cases +++ Surgery ++ Options include implantation of an intrathecal baclofen pump, rhizotomy, or neurectomy Severe contractures may be treated by surgical tendon release + Outcome Download Section PDF Listen +++ +++ Prevention ++ Physical therapy with appropriate stretching programs is important during rehabilitation after the development of an upper motor neuron lesion and in subsequent management of the patient The aim is to prevent joint and muscle contractures and perhaps to modulate spasticity +++ When to Refer ++ Refer early to a physical therapist + References Download Section PDF Listen +++ + +Ertzgaard P et al. Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen. J Rehabil Med. 2017 Mar 6;49(3):193–203. [PubMed: 28233010] + +Ramanathan RS et al. Demographics and clinical characteristics of primary lateral sclerosis: case series and a review of literature. Neurodegener Dis Manag. 2018 Feb;8(1):17–23. [PubMed: 29316850] + +Turner-Stokes L et al. A comprehensive person-centered approach to adult spastic paresis: a consensus-based framework. Eur J Phys Rehabil Med. 2018 Aug;54(4):605–17. [PubMed: 29265792]