Spasticity Management
What is Spasticity?
Spasticity is a disorder of muscle function that causes muscle tightness and spasms. Spasticity occurs when there is damage to the part of the central nervous system that controls voluntary movement. This damage or injury may result from a traumatic brain injury, stroke, cerebral palsy, multiple sclerosis, or spinal cord injury.
What are the Symptoms of Spasticity?
- Any of the following:
- Muscle spasms
- Muscle jerks
- Muscle "drawing up"
- Pain
- Tightness
- Abnormal posture
- People with central injuries to the nervous system may experience other problems such as weakness, poor coordination and decreased balance
What Problems are Caused by Spasticity?
Spasticity may interfere with activities of daily living, impair mobility, or lead to pain, difficulty sleeping and skin breakdown. It can make it difficult for care givers to assist in care. It may cause orthopedic deformities including fixed contractures (shortening of the tendons). Depression can occur due to the lack of functional independence.
Goals of Spasticity Management:
- To improve function with activities of daily living, mobility, ease of care for care givers, sleep and overall functional independence
- To prevent skin breakdown, orthopedic deformity, and the need for corrective surgery
- To reduce pain
- To allow stretching and strengthening of muscles
Therapy Options:
The first step in treating spasticity is to determine the treatment option that will best enhance the life of the patient. At the University of Utah we base the decision on your particular condition, your preferences and a physical assessment that considers muscular movements and measures the effectiveness of current treatments. Not every treatment is suitable for you or the one you care for.
Oral Medications:
Several oral medications are used to treat spasticity. The most common ones include:
- Baclofen (Lioresal)
- Tizanidine (Zanaflex)
- Diazepam (Valium)
- Clorazepate (Tranxene)
- Dantrolene Sodium (Dantrium)
Baclofen is used most commonly and has the least side effects. Oral medications may decrease generalized spasticity, but usually have only limited effects. These medications are usually started at a low dose and gradually increased to minimize side effects. The most common side effect is drowsiness and usually this can be controlled by decreasing the dosage.
Botox/Myobloc Intramuscular Injection:
Botox and Myobloc are the trade names for botulinum toxin type A (Botox) or botulinum toxin type B (Myobloc). It is a natural substance that is injected directly into specific muscles or muscle groups.
It can be given without anesthesia and has few complications. Dosage is flexible, based on the patient's weight, muscle size and level of spasticity, effects of prior injections, and treatment goals. Botulinum toxin usually starts to work in three to five days. The treatment results last approximately three to five months and can be repeated.
Phenol Intramuscular Injection:
Phenol is a type of alcohol, which chemically blocks nerves in the affected muscles to reduce the spasticity. It is given as a series of small injections into the target muscles. Phenol injections can be uncomfortable for some patients. Possible adverse effects may include pain and swelling at the site of injection. Phenol has an immediate onset of action. The effects of phenol may last for six to twelve months and can be repeated.
Combination Therapy:
Botulinum toxin and phenol may be used effectively together.
Intrathecal Baclofen Therapy:
Baclofen is a medication used to ease spasticity. The liquid form of baclofen may be administered through an implanted internal pump, which is placed under the skin of the abdomen. A catheter is attached and is placed directly to the spinal cord area, where it drips baclofen continuously. Far smaller doses are required with the intrathecal than the oral medicine because baclofen works directly at the spinal cord level. The sedation often seen with oral baclofen is frequently eliminated.
Prior to implanting a pump, patients are given a trial dose of medication via a lumbar injection to see if it is appropriate for them. After the implant, the dosage is gradually increased until the desired effect is obtained. Once placed, the pump may only have to be refilled every four to twelve weeks via an injection into the refill port of the pump. This is done in an outpatient setting. The pump is adjusted noninvasively by portable computer as often as needed. Batteries within the pump currently need replacement every five to seven years. This procedure is reversible.
Our Interdisciplinary Team:
- Rehabilitation Physicians (Psychiatrists)
- Nurses
- Physical Therapists
- Neurosurgeon
General Information:
University Health Care established the Spasticity Program to serve its patients and those in the community who have spasticity due to cerebral palsy, multiple sclerosis, stroke, spinal cord injury, brain injury, or other central nervous system problems.
We are committed to providing high-quality, comprehensive medical services for our patients and their families.
The patient and family are essential members of our University of Utah spasticity management team. Together we develop a customized treatment plan based on defined functional goals.
For more information contact:
Physical Medicine and Rehabilitation Clinic
University of Utah Hospitals & Clinics
Salt Lake City, Utah
801-581-2267
