Spasticity Management

What is spasticity?

Sometimes following injury or illness to the brain or spinal cord, muscles may become stiff and tight causing problems with movement, pain, spasms, joint deformity, hygiene, sleep and functional impairment. This increase in muscle tone is commonly referred to as spasticity.

Common causes

Spasticity is caused by damage to the upper motor neuron which travels from the brain to the spinal cord. Therefore any illness or injury to the brain or spinal cord can cause spasticity. Whilst there are many causes, the most common are detailed below.

Stroke:

A stroke occurs when the blood supply to part of the brain or brain stem is interrupted. As a result the brain is deprived of oxygen and brain cells die within minutes. This is usually caused by blockage or rupture of the artery to or within the brain.

Trauma:

Traumatic brain and spinal injury may occur when a sudden force damages the brain and/or spinal cord. The damage can be confined to one area or occur at multiple areas. The severity of the injury usually needs to be moderate or severe to cause spasticity. For a spinal injury, any impact may lead to spasticity but the location is usually above the L1 vertebra.

Cerebral palsy:

Cerebral palsy occurs as a result of damage to the developing brain. This may occur before birth, during delivery or early developing years following birth. There are different kinds of cerebral palsy with movement and muscle tone often affected.

Multiple sclerosis:

Multiple sclerosis involves an immune system attack against the myelin sheath of the nerves in the brain and/or spinal cord. This can cause permanent damage to the nerve. Spasticity can occur to the upper limbs, but is more common in the lower limbs with MS.

Common limb positions

Spasticity affects people in different ways. As muscles tighten you may find that your upper or lower limb position is affected. Prolonged muscle tightness can result in permanent muscle shortening and joint contracture. Once contractures occur treatment can be very difficult and may require surgical treatment, so it is very important to treat spasticity appropriately and early enough to prevent this from occurring.

Botulinum toxin injections

Botulinum toxin is a purified protein that is extracted from bacteria under controlled laboratory conditions. The brands available are Botox^®, Dysport^® and Xeomin^®. Intramuscular injection of botulinum toxin is a common medical procedure to treat spasticity and can be safely performed in outpatient rooms without visiting a hospital. The procedure involves injecting botulinum toxin into the affected muscles under ultrasound guidance. Once injected the medication blocks the release of acetylcholine, a neurotransmitter, from the nerve which then allows muscle fibres to gradually relax. It takes 1-2 weeks for this change to commence. The duration of effect is variable but the medication remains active for at least 3 months. The benefits may be improved through participation in a therapy and orthotic program although repeat injections are usually required for ongoing clinical benefit. It is important to note that botulinum toxin can be less effective if spasticity has become severe, so the sooner spasticity is diagnosed, the better the outcome can be.

Botulinum toxin is listed on the Pharmaceutical Benefits Scheme for the treatment of spasticity. This means it can be accessed at little or no cost to the patient, making this procedure far more affordable than it has been in the past.

Goals of treatment

Because spasticity affects people in different ways, each person may have different goals. It is important that goals are realistic and achievable. Goals may include: