Multiple Sclerosis Spasticity

What is spasticity?

Spasticity, one of the most common symptoms of multiple sclerosis (MS), ranges from feelings of mild stiffness to involuntary sudden muscle movements or painful muscle spasms caused by misfiring of damaged nerves. The degree of MS spasticity is highly individualized; it ranges from mild to severe and can occur in any muscle but most commonly occurs in the legs. MS spasticity has the potential to cause secondary pain (nociceptive pain), as well. Secondary pain in other muscles and joints, not affected by the nerve issues of MS, is often caused by changes in posture to compensate for spastic muscles. It is important to note that, in some cases, spasticity can be helpful, especially when walking is an issue due to weak leg muscles.

Types of spasticity

Flexor spasticity and extensor spasticity are the two most common types of spasticity.

• Flexor spasticity typically affects the muscles in the back of the upper legs (hamstrings) or the muscles in the front of the upper thighs (hip flexors). The muscles become so tight that the limbs become bent and difficult to straighten.
• Extensor spasticity typically affects the muscles in the front and inside of the upper legs (quadriceps and adductors). The limbs remain straight and are difficult to bend because the muscles are so tight.

Triggers for spasticity (Header 1)

Spasticity triggers include, but are not limited to, the following:

• Abrupt movements or position changes
• Temperature extremes
• Humidity
• Infections
• Tight clothing

Treatments for multiple sclerosis spasticity

Various treatments are available for multiple sclerosis spasticity. They include, but are not limited to, the following:

Physical therapy

Physical therapy for multiple sclerosis involves stretching exercises that can help relax and lengthen the muscles. Regularly stretching the muscles has the potential to not only relax the muscles when spasms are active but also to reduce the frequency of muscle spasms.

Occupational therapy

Occupational therapy may also be recommended. An occupational therapist may splint, brace or cast a limb to prevent seizing of the muscle. The idea is to keep muscles taut to prevent or reduce the loss of range of motion.

Medications

A wide variety of prescription medications are available to ease multiple sclerosis spasticity. The medications used to treat MS spasticity work in different ways and are prescribed according to the severity of spasticity. They include, but are not limited to, the following:

• Muscle relaxants, such as baclofen and tizanidine, are commonly prescribed to treat MS-related muscle spasms. Baclofen is available in pill form, or in more severe cases, intrathecal baclofen may be needed (a pump surgically inserted into the back consistently delivers the medication). Dantrolene, also a muscle relaxer, may be prescribed if other muscle relaxants are ineffective; however, it may cause liver damage and blood abnormalities.
• Benzodiazepines, such as diazepam and clonazepam, may be prescribed to ease muscle spasms. As with most medications, various side effects, such as dizziness and fatigue, are associated with these medications
• OnabotulinumtoxinA is often thought of as a vanity drug, but it has far more valuable medical applications than the reduction of wrinkles. It is used in some cases of multiple sclerosis to relax the muscles. It is administered via intramuscular injection.

Medical cannabis

Cannabis can provide relief of muscle spasms in some individuals with MS. Oral applications of cannabis are most recommended due to reduced potential side effects. Because cannabis is not legal in some locations, it is important to check local laws before use.

Surgery

Surgery is rarely used to treat multiple sclerosis spasticity, but it is an available option for severe cases of spasticity.

• Rhizotomy is a surgery that involves cutting away part of the spinal nerve to reduce pain and ease muscle tension.
• Tenotomy, or tendon release, is a surgery that involves cutting tendons away from the muscles to reduce the frequency and severity of spasticity.People with Multiple Sclerosis oftentimes experience painful muscle spasms. These spasms cause the muscles to tighten, often painfully, and refuse to relax, a lot like an intense muscle cramp. MS muscle spasms are due to the misfiring of damaged nerves. These muscle spasms are not only painful themselves, but they have the potential to cause secondary pain, referred to as nociceptive, as well. This means that postural changes or compensating for spastic muscles may lead to pain in other muscles and joints that are currently not being affected by the nerve issues of MS.