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Spasticity or muscular hypertonicity is a disorder of the body motor system, and especially the central nervous system (CNS), in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and may interfere with gait, movement, and speech. Depending on severity, the person with the spastic muscles may or may not feel it. However, it can often be severely disabling. The human motor system is not always linked with the sensory systems, nor the voluntary-muscle systems.

Spasticity is most common in spastic diplegia and other forms of spastic cerebral palsy, but it also presents extensively in multiple sclerosis and to different degrees in most other neuromuscular conditions as well, both progressive and not.

Presentation

Symptoms may include hypertonia (increased muscle tone), clonus (a series of involuntary rapid muscle contractions), exaggerated deep tendon reflexes, muscle spasms, scissor gait, and over time, shortened tendons and fixed joints (contractures). The degree of spasticity varies from mild muscle stiffness with minimal impact on function to severe and painful joint and muscle breakdown and uncontrollable muscle spasms.

The condition often interferes with daily activities. Over the years, it may increase in its effect, so more severe treatments may be needed later. Cold weather and fatigue can trigger spasms more severely than other times. The constant spasms can lead to muscle fatigue so periodic rest is required but often difficult to achieve. Multi-tasking (such as walking, talking, eating and other activities) can also trigger more severe spasticity.

Possible benefits

In patients with spastic cerebral palsy, a wider margin of neurosurgeons — due to observation of extensive and continually worsening joint, muscle and bone stress resulting from spasticity over decades of early life (20s, 30s, etc.), and the fact that such extreme pressure from the spasticity is not at all what the human body is meant to accommodate, thus automatically predisposing the spastic-muscled individual to very early-onset arthritis, joint deformities, hip pain, and other problems — are now reaching a consensus that there is, in fact and directly contrary to past convention, actually no positive overall benefit to spasticity in an individual at any stage of life — and moreover, if such spasticity can be neurosurgically eliminated, such as through a selective dorsal rhizotomy, it should be done as early in the life cycle as possible, preferably the pediatric period, to save the person from needing to deal with a lifetime of spastic movement.

However, in patients with multiple sclerosis or other neuromuscular conditions with a different basis than cerebral palsy (that is, conditions where the spasticity/weakness dynamic changes when the condition changes, which does not happen in CP), possible benefits of spasticity may indeed exist. Until recently, these benefits were thought by the medical community to also be true in case of cerebral palsy spasticity, and with the exception of a few notable orthopedic surgeons and neurosurgeons worldwide who now disagree, these 'benefits' continue to be conventional wisdom as concerns CP issues and others.

Common arguments for benefits of spasticity to the function of a given person are that spasticity:

• May help some patients to walk, stand or transfer (e.g., stand pivot transfers)
• May assist in maintaining muscle bulk, i.e., in exercising the muscles, inherently preventing atrophy
• May assist in preventing DVTs
• May assist in preventing pressure ulcer formation over bony prominences
• Can be used as “diagnostic tool” (with increased spasticity being a sign of exposure to a noxious stimuli—infection, bowel impaction, urinary retention, etc) [1]

Treatment

If the cause is fatigue, the first remedy is rest or relaxation. Massage feels incredibly good but only provides temporary relief. Stretching the muscles involved also feels good but only provides temporary relief. Chronic spasms can lead to shortening of the muscles and ligaments. Regular (daily) exercises over the years ahead of these ligaments and muscles are needed to prevent the pain and the crippling of movement.

Treatment may include such medications as baclofen, diazepam, dantrolene, or clonazepam; muscle stretching, range of motion exercises, and other occupational therapy or physical therapy regimens to help prevent joint contractures (shrinkage or shortening of a muscle) and reduce the severity of symptoms; or surgery for tendon release or to block the connection between nerve and muscle, so that the muscle does not contract. The connection between nerve and muscle may also be blocked temporarily, without surgery, by injecting botulinum toxin into the muscle. In spastic CP, selective dorsal rhizotomy may also be considered.

Some jurisdictions have also issued medical marijuana to help treat spasticity.

Prognosis

The prognosis for those with spasticity depends on the severity of the spasticity and the associated disorder(s). To a small degree spasticity performs the helpful role of exercise, but it is usually bothersome to normal activities in life.

See also

• cerebral palsy
• Spastic Diplegia
• Gamma-aminobutyric acid
• rhizotomy
• phenol
• baclofen
• diazepam
• dantrolene
• clonazepam
• tizanidine
• transverse myelitis

References

• "Other Complications of Spinal Cord Injury: Spasticity." (Louis Calder Memorial Library of the University of Miami/Jackson Memorial Medical Center, October 3, 2002), http://calder.med.miami.edu/pointis/spasticity.html

• Maureen E. Neistadt and Elizabeth Blesedell Crepeau, ed. (1998). Willard and Spackman's occupational therapy. Philadelphia: Lippincott-Raven Publishers, 233. ISBN 0-397-55192-4. 

• This article contains text from the public domain document at http://www.ninds.nih.gov/health_and_medical/disorders/spasticity_doc.htm

External links

• Patient Site giving information on Intrathecal Baclofen Treatment for Spasticity as a result of Cerebral Palsy
• The Spastic Centre - Sydney, Australia

Wikipedia content modification information:

• This page was last modified on 22 August 2008, at 19:42.

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