Spasticity is a physiological consequence of damage to the brain or spinal cord and typically occurs in conditions such as stroke), head trauma, multiple sclerosis, cerebral palsy, and others. Abnormal muscle contraction cause the spastic limbs to lose flexibility, causing pain and mobility problems for sufferers Learn the characteristics and causes of the condition, methods of diagnosis and the various treatment options available.
Spasticity is due to an exaggerated contraction of the muscle reflex which is triggered by stretching the muscle. This hypertonia is caused by disinhibition of the myotatic reflex (the reflex that contracts the muscle in response to stretching it) following damage to the brain or spinal cord. The term spasticity is used to describe all muscular activity secondary to central nervous system damage.
The increase in muscle tone can be very disabling and cause continuous and sometimes very powerful contraction at rest, and extremely intense contractions in response to the slightest stimulation. It may become impossible to straighten out the limb, creating motor difficulties and pain for patients.
Symptoms and impact on health
Spasticity develops gradually and generally takes several weeks to become established. It concerns a small or large muscle group, and the location depends on the location of the damage to the brain or spinal cord:
- Location in cases of cerebral stroke or traumatic brain injury: generally speaking, one side of the brain is affected and causes either partial (paresis) or complete paralysis of the opposite side of the body. Here, spasticity can affect the whole of one side of the body, the upper or lower limb.
- Location in cases of multiple sclerosis (MS): patients with MS may have lesions that affect the brain and/or the spinal cord. In MS, spasticity can affect the lower limbs and causes problems with walking.
In clinical terms, there are two signs of spasticity:
- an increase in the stretch reflex, or in other words, an exaggerated contraction of the muscle reflex;
- muscular hypertonia, which is the characteristic elastic resistance to continuous stretching of the muscle.
Complications vary: when spasticity is severe, changes to the muscular structure take place over time (muscular retraction or contracture), which are difficult to differentiate from the actual spasticity itself. Movement and balance problems, shaking, pain, inhibition of growth in children, and impacts on quality-of-life are also possible.
Appearing in different forms, spasticity is found with the majority of neurological deficit conditions, as a result of:
- head trauma,
- spinal cord injury,
- multiple sclerosis,
- cerebral palsy.
It is estimated that approximately one-third of stroke patients, 60% of patients with severe MS, and 75% of patients with physical disability following severe traumatic brain injury will develop spasticity requiring specific treatment
Spasticity develops gradually
Rigorous clinical analysis is required to diagnose spasticity
Treatment is not always called for
RCP national guidelines, « Spasticity in adults : management using botulinum toxin » Jan 2009
Bandi, S. & Ward A.B. http://sphhp.buffalo.edu/content/sphhp/rehabilitation-science/research-and-facilities/funded-research-archive/center-for-international-rehab-research-info-exchange/_jcr_content/par/download/file.res/pdf.zip Last accessed 18/07/2017
Intrathecal baclofen https://www.medicines.org.uk/emc/medicine/1295 Last accessed 18/07/2017