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For further information, see CMDT Part 24-22: Spasticity

Key Features

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, urinary or other infections, and nociceptive stimuli

Clinical Findings

  • 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

  • Clinical

Treatment

Medications

  • Pharmacotherapy is important, but it may increase functional disability when increased extensor tone is providing additional support for patients with weak legs

  • The following regimens are often helpful

    • Baclofen, 5–10 mg twice daily orally, titrated up to 80 mg daily as tolerated

    • Tizanidine, 2–8 mg three time daily orally

    • Diazepam, 2–10 mg three times daily orally

    • Dantrolene

      • Dosage: 25 mg once daily orally, titrated every 3 days as tolerated to a maximum of 100 mg four times daily

      • Best avoided in patients with poor respiratory function or severe myocardial disease

  • 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

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

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Ertzgaard  P  et al. Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen. J Rehabil Med. 2017;49:193.
[PubMed: 28233010]  
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Kudva  A  et al. Intrathecal baclofen, selective dorsal rhizotomy, and extracorporeal shockwave therapy for the treatment of spasticity in cerebral palsy: a systematic review. Neurosurg Rev. 2021. [Epub ahead of print]
[PubMed: 33871733]
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Palazón-García  R  et al. Botulinum toxin: from poison to possible treatment for spasticity in spinal cord injury. ...

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