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